S1 The role of practice-based research in stimulating educational innovation in healthcare

Sandra Hasanefendic (s.hasanefendic@vu.nl)

Practice-based research is not uncommon in healthcare. In fact, the way nurses and doctors train is through extensive and intensive practice [1]. In other words, practice-based research has been used to gain new knowledge partly by means of practice and the outcomes of that practice [2]. Practice based research networks have also been gaining on importance in healthcare as ways of addressing research questions informed by practicing clinicians. They aim to gather data and improve existing practices of primary care [3], practice-based research is not only about gaining new knowledge via practice and improving existing practices.

Objective

In this presentation/paper I explain and highlight the role of practice-based research as an instrument for educational innovation in healthcare sciences.

Methods

I used interview excerpts and examples of projects related to healthcare at different universities of applied sciences in the Netherlands and Germany (also known as polytechnics in Portugal) to advance the role of practice-based research in educational innovation. This type of research is an integral part of teaching and curricular assignments in the healthcare settings in the Netherlands and Germany, and particularly at universities of applied sciences. I emphasized how practice-based research can improve and enrich the curricula, while at the same time, building necessary skills of future healthcare professionals and improving practices in already existing healthcare institutions.

Results

I show that practice-based research is in fact short term problem-oriented research which serves educational purposes by upgrading students’ and teachers’ skills and knowledge of the profession and dynamics in the work environment; which also has the potential to improve company products or design solutions and at the same time contribute to local and regional innovation in professions and profession related institutions [4-5]. Its role is multidimensional and dialectic insofar it serves multitude goals and is accomplished in dialogue among relevant stakeholders [6]. Practical suggestions for healthcare educators and practitioners in designing their curricula to incorporate the basic elements of this practice-based research are also offered in this presentation/paper.

Conclusions

Practice-based research is more than knowledge acquisition via practice. Its role and goals expand to enriching educational curricula with a more comprehensive engagement of external and professional stakeholders, at the same time contributing to student soft and professional skill development and solving stakeholder problems or optimizing services and products at local or regional levels.

6. Hasanefendic S, Heitor M, Horta H. Training students for new jobs: The role of technical and vocational higher education and implications for science policy in Portugal. Technological Forecasting and Social Change. 2016; 113: 328-340.

S2 Is sexuality a right for all? Sexual revolution in the old age

Francisco J Hernández-Martínez (francisco.hernandezmartinez@ulpgc.es)

“Do not you think your grandmother has sex? What happens with old gays? Why does a kiss between two elders tenderizes us and we do not think it is erotic” (interview, Ricardo Iacub, 2018). It still impacts us, and what do we do with it? Do we let it pass? Do we encourage them?

Throughout the centuries, sex has been postulated as the impulse that gives life to people. This word, of Latin origin, has always aroused much interest in society and in all stages of life; but it must be differentiated from “sexuality”, because it contemplates various aspects among which it is found; sex, identities and gender roles, eroticism, pleasure, intimacy, reproduction and sexual orientation [1-6]. Sexuality is a vital dimension that is present in all stages of life, at least since adolescence. It contributes significantly to health and quality of life and is, moreover, a right recognized by international organizations such as the World Health Organization (WHO) [4, 7-9]. Despite this, old age has traditionally been considered as a stage in which sexual needs would be absent, in which people are no longer interested or have the capacity to lead an active sexual life [3-8, 11]. Master and Johnson, two famous American sexologists, argued that older people should fight against a false belief, which considers that “sexual incompetence is a natural component of the aging process”. This belief limits access to sexuality due to fear of failure, to consider that it is no longer correct, that it can be sick or perverse. The same authors pointed out that many of their patients had gone to priests, rabbis, doctors or psychologists and that they had received the answer “it is logical at their age” [3, 7, 10]

The studies carried out, in our country and internationally, show that the majority of the elderly, and especially those who have a partner, are still sexually active until very old ages [6-9]. The keys to continue carrying and enjoying a quality sexual life in old age should be recognized and admitted at a social level, and among others, we should start; to be free of prejudices and stereotypes that condemn the elderly to lack of desire, or that associate sexuality in old age to something dirty or morally condemnable. Stop associating youth and sexuality. Do not assume the possible problems or difficulties that may appear as irreversible barriers. Age influences the decrease in sexual activity and interest, but not in satisfaction. It is demonstrated that sex and sexuality play an important role in healthy and full aging [1-3, 6-9, 11]. Taking into account these premises, throughout the presentation will present the results of a study conducted in the Canary Islands among people over 65 years, users of senior centers whose main objective was; obtain data on sexual activity, sexuality and whether age-related pathologies have affected their sexual relations. Against these prejudices, older adults need, want and seek some kind of loving exchange; “Old people want and need to talk about sex”, and also young people need to think that we have a lifetime to continue enjoying and experimenting with our sexuality.

João Apóstolo (apostolo@esenfc.pt)

The Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A Joanna Briggs Institute Centre of Excellence, Nursing School of Coimbra, 3000-232 Coimbra, Portugal

Background

Frail older adults are more susceptible to falls, fractures, disability, dependency, hospitalization and institutionalization [1]. Physical and cognitive decline, associated with frailty, potentiate the development of geriatric syndromes and lead to a decrease in self-care, depressive vulnerability and a decrease in quality of life [2]. Adapted physical exercise and cognitive stimulation allow the maintenance of physical and cognitive capacities, which is reflected in an improvement on the functional status of the elderly and in a reduction of associated comorbidities [3].

Objective

To promote independent living in frail older adults by improving cognition and gait ability and using assistive products.

Methods

It is planned to develop a combined intervention that will be composed by a digital cognitive stimulation program and an adapted physical exercise program. It is also being developed an auto-blocking kit mechanism for rolling walkers as an assistive product that could be used during the physical exercise program. A randomized-controlled trial will be developed to test the efficacy of the combined intervention in frail older adults. At the same time, a web platform will be developed and it will be used as a repository, providing digital intervention’ materials and results.

Results

Through the implementation of a multidisciplinary strategy, significant benefits are expected in the prevention and maintenance of physical and cognitive decline of the frail older adults. It is hoped that for frail older adults the combined intervention and its digital components would be synonymous of autonomy and improvement of their quality of life, contributing to active aging. The project, being based and tested in clinical practice, will guide health professionals, caregivers and general public to promote the independence of this population.

Conclusions

Cognitive interventions and physical exercise have impact on cognitive decline, a condition that assumes more importance once it is related with frailty in older adults. This multidisciplinary strategy gives the opportunity to older adults to act actively in their health through the spontaneous performance of cognitive and physical exercises available on the web platform. The components of the combined intervention will allow better reintegration of this population into society of today’s world. By promoting research policies among educational institutions and health service delivery institutions, the MIND & GAIT project will make health care available to the frail elderly population more accessible to professionals, caregivers and general public.

Trial Registration

NCT03390478

Acknowledgements

The current abstract is being presented on behalf of a research group. It is also part of the MIND&GAIT project Promoting independent living in frail older adults by improving cognition and gait ability and using assistive products, which is a Portuguese project with the support of COMPETE 2020 under the Scientific and Technological Research Support System, in the co-promotion phase. We acknowledge The Health Sciences Research Unit: Nursing (UICISA: E) of the Nursing School of Coimbra, the Polytechnic Institute of Leiria, the Polytechnic of Santarém, Polythecnic of Coimbra and also to other members, institutions and students involved in the project.

S4 Electronic health records in Portugal

Cristiana Maia (academia@spms.min-saude.pt)

In the digital transformation Era, there is an increasing need to provide systems capable of offering functionalities that allow the user a quicker and easier access to healthcare related information’s. These digital services aim to provide access to more information, allowing the users to make better informed decisions.

In Portugal’s National Health Service Portal (SNS Portal www.sns.gov.pt), there are already several digital services available, the Citizen’s Area aggregates these services for the user.

Citizen’s Area main objectives is to facilitate communication and interaction between Citizens, Professionals and Health Institutions, allowing access to information in an integrated way, providing a better healthcare. Simple and accessible to all users, this area allows personal health information access in one place at any time, thus avoiding unnecessary commuting. This area has access monitoring and permission policy configurations, allowing the Citizen to view access history and configure access permissions to their health information, thus increasing control and management of their own personal health information.

S5 Economic crisis and inequalities in the Southern European health systems

Mauro Serapioni (mauroserapioni@ces.uc.pt)

Despite the overall increase in living standards and the introduction of universal health systems, many studies have identified persistent inequalities in all industrialized countries. The Southern European countries, namely Greece, Italy, Portugal and Spain, although the reforms of the 1970s and 1980s introduced universal national health services, social inequalities in health only became a critical issue in the late 1990s. However, the issue of health inequalities became a priority from 2010-2011, when (although with different degrees of severity) the four countries began to feel the first effects of the financial crisis. Various studies have identified the impact of the economic crisis on the most vulnerable population groups, with increasing rates of mental health disorders and a rise in suicides.

Objective

After a brief contextualization of the welfare state in southern European countries and a characterization of health systems in Greece, Spain, Italy and Portugal, the main health inequalities are described, identifying the potential inequity induced by the reform processes undertaken and the current austerity policies implemented.

Methods

The study resulted from a non-systematic literature review, based on the Scoping review proposal. A total of 74 publications were analysed.

Results and Discussion

The analysis has highlighted common characteristics and trends in the Southern European health systems, as well as some significant differences between them. In the four countries, the social gradient (particularly in education, income, and work status) is the principal determinant factor in health inequalities. Another key aspect is the steady increase in out-of-pocket spending in health as a percentage of total health spending in all four countries, markedly in Greece and Portugal. The analysis has identified potential inequalities induced by the reform processes, as result of new relations between the public and private sectors in services provision. Another example of how health systems produce inequalities is the rising proportion of users’ health expenses covered by co-payments and user fees. Geographic inequality in health is another critical issue, observed in all four Southern European countries. Finally, the recent debate in the international literature on the relationship between different welfare state regimes and health inequalities will be discussed.

Conclusions

The crisis and austerity policies have greatly increased the level of dissatisfaction with healthcare provision in these countries.

Correspondence: Maria P Guarino (maria.guarino@ipleiria.pt)

Background

Type 2 diabetes mellitus (T2DM) is a highly prevalent disease worldwide which is asymptomatic in about 44% of patients being critical to search for new ways of early diagnosis. Recent studies have demonstrated that the etiology of this disease may be associated with alterations in the function of the carotid body (CB), a chemosensor organ located within the bifurcation of the carotid artery. In animal models of metabolic syndrome, it was observed that the CBs are overactivated, underlying diseases such as obesity, hypertension and T2DM. This discovery provided a new paradigm in the neuroendocrinology field, suggesting that diagnostic function of the CBs has predictive value for the development of metabolic diseases. Despite this fact, it is not common in clinical practice to look at the CBs as organs associated with endocrine dysfunction and we believe this is probably due to the nonexistence of a user-friendly, portable medical device that diagnosis the function of the CBs.

Objective

The general aim of this work is to develop a novel device that evaluates the function of the carotid bodies - a CBmeter. We are also developing a standard test meal to be used as a physiological dynamic test during CBmeter utilization.

Methods

This medical device will synchronously assess several physiological variables: heart rate, respiratory rate, blood pressure variation, arterial pulse oximetry and circulating glucose, as well as the physiological responses to hyperoxia and meal ingestion. The results obtained will be analyzed using MatLab, in order to develop an algorithm with predictive value for early diagnosis of metabolic diseases. We are also developing a standard test mixed- meal to assess post-prandial glucose excursions with the CBmeter. The work is currently in the prototype development phase.

Results

A preliminary pilot-test performed with the prototype revealed that all the proposed variables are assessable with the CBmeter. The standardized test meal used in the pilot-test caused a glucose excursion curve that stabilized 30 minutes after ingestion, being suitable for metabolic evaluation with the CBmeter. Interstitial glucose variation was 16.6mg/dl glucose with a latency time of 21min. Heart rate did not vary significantly after the meal ingestion.

Conclusions

The CBmeter prototype is currently optimized to be used in a medical device clinical-trial with healthy volunteers. The mixed meal developed has proven to be suited in healthy volunteers to determine variations in CB-related cardiorespiratory parameters.

Acknowledgements

Project funded by FCT/SAICT-POL/23278/2016

Keywords

Carotid body, Diabetes, Early diagnosis, Medical device.

S7 Help to care for users and caregivers: Help2care

Maria dos Anjos Coelho Rodrigues Dixe1,2 (maria.dixe@ipleiria.pt)

There are several studies showing that the family members providing care to their relatives need to acquire abilities that enable them to be competent in their performance, having the health care professionals an indispensable role in their training [1]. Empowering caregivers can help in reducing health care costs, improve the quality of life of both user and caregiver [2], their mental health [3] and greater satisfaction with their care [4]. The continued support to caregivers can help them in decision making in less serious heath situations and to use fewer health services [5].

The main aims are: to construct assessment instruments to evaluate the patient and caregivers needs and abilities concerning self-care; to develop a support manual accessible to all caregivers; to make videos that demonstrate technics and task procedures to support the caregiver in the caring process; to develop a digital platform where all the developed resources will be available (website and app) to support the care transition from the hospital to the residence integrating professionals from the hospital and from the primary healthcare services; to empower health professionals to use the caregivers’ and users’ self-care empowerment model.

This project will include participation of students, teachers, researchers and stakeholders throughout the project using an action research, where, as the materials are developed, the population target acceptance will be tested, justifying the corrections needed before moving to the next step, using a consistent methodology with an action and learning research process. Population: The population will be: dependent patients diagnosed with a chronic illness, total or partial dependency admitted to the Hospital and require caregiver after hospital discharge; Informal Caregivers whose dependent members of the family present the criteria laid up and Heath professional. To evaluate the patient and caregivers’ needs and capacity concerning self-care we will construct them (activity 1). During the pilot test period we will have, two kinds of metrics: Qualitative metrics available on (http://garyperlman.com/quest/). And quantitative monitoring metrics for the use of the mobile app, including retention rate, churn rate, daily active users (DAU), daily sessions per DAU and stickiness, and also access statistics per module/feature on the app.

The mains output will be: A training model of caregivers and users for self-care composed with: a caregiver’s. support manual; a digital platform and a manual with the empowerment model to be used by health professionals

Acknowledgements

The current abstract is being presented on behalf of a research group. It is also part of the Help2care - project: Help to care for users and caregivers, which is a Portuguese project with the support of COMPETE 2020 under the Scientific and Technological Research Support System, in the co-promotion phase. We acknowledge the Polytechnic of Leiria, the Polytechnic of Santarém, Polythecnic of Castelo Branco, Centro Hospitalar de Leiria and also to other members, institutions and students involved in the project.

Adolescent obesity has reached epidemic proportions, being urgent to find effective prevention strategies. The core components of classic prevention programs have been unable to obtain the desired adherence. The solution may involve a more extensive and frequent contact with the healthcare team and the use of alternative communication channels and interacting/dynamic technologies with adolescents. TeenPower is a transdisciplinary practice-based action research project that aims to develop innovative interventions to promote healthy behaviors. This project is promoted by the polytechnics of Leiria, Santarém and Castelo Branco, Município de Leiria (City Council), as well as local schools and primary healthcare stakeholders, key partners in the development phase and in the implementation of the intervention program.

Objective

The main goal is the development, implementation and evaluation of a program for the promotion of healthy behaviors and prevention of obesity in adolescence, based on e-therapy and sustained by the case management methodology. The project is directed to the cognitive-behavioral empowerment of adolescents, through increased and interactive contact between adolescents and a multidisciplinary healthcare team. The use of Information and Communication Technologies (ICT) in the intervention can optimize resources and maximize impact, as a complement to conventional approaches.

Methods

The project includes the development of three complementary studies: (S1) evaluation of adolescents’ health status and cognitive-behavioral indicators, (S2) usability evaluation of the TeenPower platform and mobile app (S3) implementation and adherence evaluation to the TeenPower intervention program. Participants will be recruited from the school groups of Leiria, Santarém and Castelo Branco, aged between 12 and 16, with easy access to internet and smartphone/tablet (inclusion criteria). Intervention include behavioral, nutritional and physical activity counselling (online and face-to-face psycho-educative sessions). The e-therapeutic platform and mobile app (TeenPower) includes educational resources, self-monitoring, social support, interactive training modules and motivational tools. In addition to the case manager, the program will also have the direct support of an interdisciplinary team (nurse, nutritionist, exercise physiologist, among others).

Results

Expected results includes the delivery of the TeenPower intervention program, including an interactive application (web and mobile); scientific papers, communications and reports; workshops and conferences. We will evaluate adolescents’ health status and cognitive-behavioral indicators, evaluate Teenpower usability and program adherence.

Conclusions

The positive evaluation of the intervention program will stimulate the inclusion of ICT in the promotion of salutogenic behaviors and overweight prevention, creating technological interfaces that will allow customizing the intervention parameters and facilitating the monitoring and tracking.

Acknowledgements

The current abstract is presented on the behalf of a research group, the TeenPower research team. It is also part of the project TeenPower: e-Empowering teenagers to prevent obesity, co-funded by FEDER (European Regional Development Fund), under the Portugal 2020 Program, through COMPETE 2020 (Competitiveness and Internationalization Operational Program). We acknowledge the Polytechnic Institutes of Leiria, Santarém and Castelo Branco, the Municipality of Leiria (city council), and also other members, institutions and students involved in the project.

Keywords

Adolescents, Obesity, Health promotion, e-health, Mobile.

S9 The Early Warning System for Basic School - SAPIE-EB in the promotion of school success, psychological health and career development

Pedro Cordeiro, Paula Paixão

Correspondence: Pedro Cordeiro (pedrcordeiro@gmail.com)

We present the “Sistema de Alerta Precoce do Insucesso Escolar no Ensino Básico (SAPIE-EB)”, a sophisticated early warning system that ealy flag the students’risk for school failure and ill-being, systematically monitor the students’ progress in the dimensions of and empirically assess the educational impact of the interventions in the dimensions of academic success, psychological health and career development. The SAPIE-EB is a user-friendly system that converts students’ raw data available at schools in knowledge, providing easy-delivered and intuitive reports on students’school failure, dropout and interventions, hereby allowing to deepen the knowledge about their causes and explanatory processes. The SAPIE-EB will be tested in 75 Portuguese basic schools. It is expected, with the implementation of the SAPIE-EB to reduce school retention in about 3% in a two-year interval period. Longitudinal research will attest the efficacy of the SAPIE-EB, from longitudinal quase-experimental research designs.

Keywords

Early Warning Systems, SAPIE-EB, School Success, Psychological Health, Career development.

O1 Nursing professionals victims of verbal abuse by their coworkers from the same work unit

Maiara Bordignon, Inês Monteiro

School of Nursing, University of Campinas Campinas, 13083-887 Campinas, São Paulo, Brazil

Correspondence: Maiara Bordignon (bordignonmaiara@gmail.com)

Background

Violence among professionals of health teams has been exploited over the years with considerable attention to nursing [1-5]. The literature has also highlighted the impact of horizontal violence on the individual, unit and institution, such as, its negative influence on job satisfaction and possible harms to the safety culture, as well as to the wellbeing of professionals [3-5].

Objective

To present the frequency with which nursing professionals have suffered verbal abuse perpetrated by their coworkers, from the same work unit, during the last year and the professional categories involved in the abuse.

Methods

A cross-sectional study performed with a sample of 267 nursing professionals – registered nurse, nursing assistant/technician – working in Emergency units in Brazil. The experience of verbal abuse at work suffered by nursing professionals in the last 12 months was accessed using questions of a questionnaire about verbal abuse [6]. Data were described allowing to identify frequencies and professionals involved in the abuse. This study was authorized by institutions and approved by the Ethical Research Board of the university.

Results

Among the victims of verbal abuse, 23 (15%) nursing professionals reported that the last verbal abuse suffered was from coworkers of the same work unit, excluding abuses perpetrated by a boss or supervisor. At least twenty-one (91%) cases occurred in the emergency units that were part of the study and of these eighteen professionals indicated the perpetrator's profession, revealing that in nine (50%) cases the abuse was perpetrated by a coworker with the same profession, mostly registered nurse-to-registered nurse (5–56%). When the perpetrator's and the victim's profession were different (9–50%), the abuse occurred more frequently from nursing technician-to-registered nurse (3–33%). The presence of the doctor was identified in at least one situation of abuse occurred in the emergency units studied and was directed to a nursing technician. There was no report of verbal abuse perpetrated by other professionals of the nonmedical team and who did not participate in the nursing team.

Conclusions

Our study showed that in almost all instances verbal abuse occurred among the nursing staff professionals themselves. Organizational policies and strategies focusing on violence contributors factors in health care teams need to be structured to prevent violence among professionals, representing a challenge to health management.

Acknowledgements

Authors are grateful for the funding by grant#2016/06128-7, São Paulo Research Foundation (FAPESP), National Council for Scientific and Technological Development (CNPq) and Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil.

Correspondence: Otília Zangão (otiliaz@uevora.pt)

Background

In contemporary society, ageing is a phenomenon that marks all developed societies. Portugal is one of the most aged countries in Europe. Currently, Portugal shows a life expectancy at birth of 81.3 years, an average value in terms of EU [1]. Social representations allow access to lay forms of thought, fundamental for understanding social phenomena and their consequences, and for the construction of scientific knowledge itself [2]. The Social Representations conduct “the behaviors and the practices and, in this way, justify the positions taken and the behaviors” [3]. Analyzing the social representations of violence on the elderly, from the current and past conceptions and daily practices of the elderly, allows us to have access to the dominant constructions in society about the social phenomenon that is violence and the way it is socially and individually expressed by its main actors.

Objective

To analyze the social representations of a group of elderly people about violence on the elderly and the reasons why this violence occurs.

Methods

Exploratory and descriptive research with qualitative approach, supported by Theory of Social Representations. It was attended by 237 elderly people aged 65-96 years, from the project “Ageing Safely in Alentejo” from University of Évora. The Free Speech Association technique was used and data were processed through qualitative data analysis software. All ethical procedures of human research were followed. Thus, all necessary authorizations for the study were requested, such as informed consent to the elderly. All conditions of anonymity and confidentiality of the responses obtained were also guaranteed.

Results

In social representations of violence on the elderly, the words most evoked by the elderly were injustice, to which were added: mistreatment, badness, bad, lack of respect, sadness, horrible and abandonment. In social representations about the reasons that lead to violence on the elderly, the words such as: lack of respect, lack of education and badness were predominant. These terms refer to the social devaluation of the elderly and their role in today's society, as in the representations about violence.

Conclusions

The social representations of these elderly people about violence and their reasons points to the stereotypes associated with the prevalent ageism in our society, where the social devaluation of the elderly dominates the daily life conceptions and practices.

Acknowledgements

This study was carried out under the ESACA - Ageing Safely in Alentejo - Ref: ALT20-03-0145-FEDER-000007, financed by Alentejo 2020, Portugal 2020 and EU.

Correspondence: Paula C Santos (paulaclara@ess.ipp.pt)

Background

Childhood and adolescence are determinants of musculoskeletal development, and the attitudes and habits adopted during these periods can have repercussions in adult life. The increasing use of technologies is becoming more worrying due to the sustained and prolonged postures due to the use of these devices and the consequent impact on musculoskeletal health.

Objective

This study analyzes the relationship between the use of new technologies with musculoskeletal symptoms (MSS) in children and adolescents.

Methods

Cross-sectional study with a sample of 460 students aged between 10 and 18 years. Data were collected through a questionnaire that included the Nordic Musculoskeletal Questionnaire.

Results

98.5% of students reported the used a mobile phone, 84.3% laptop and 52.4% tablet. Only 50.0% of the individuals who used mobile phones, 48.5% of the laptop and 31.1% of the tablet considered having a correct posture during the use of these technologies. We verified that the individuals with MSS showed more times of use of new technologies than individuals without MSS. There were differences in the time (min/day) of mobile phone and laptop use among children and adolescents, respectively 102.6 ± 121.47 vs 205.8 ± 175.89 (p < 0.001) and 74.0 ± 78.08 vs 117.9 ± 127.26 (p < 0.001).

Conclusions

Most students use new technologies in their daily lives, with less than half of them considering using these technologies in the right posture. It was also verified that individuals with MSS used more times new technologies than individuals without MSS. The time of use of new technologies increases with the age.

Correspondence: Jorge Bravo (jorgebravo@uevora.pt)

Background

Recent literature reinforces that interventions for fall prevention should include multimodal training [1]. However, even multimodal training tends to focus on exercises separately in single physical, cognitive or environmental hazards variables. An ecological approach to explain phenomena’s such as fall occurrence, underlines not only the accumulative effect of isolated variables but also interactions between different variables.

Objective

To reduce a set of correlated variables to a smaller number that may explain fall occurrence.

This pilot study showed that multiple correlated variables for fall risk assessment can be reduced to three uncorrelated components characterized by: physical and cognitive fit; health and environmental conditions; and alertness. The first two were the main determinants of falls. Recommendations: Interventions for fall prevention should privilege multimodal training including tasks that work simultaneously physical fitness, cognitive fitness and alertness, considering participant’s specific health and environmental conditions.

Correspondence: Paula C Santos (paulaclara@ess.ipp.pt)

Background

We are currently facing a society of adolescents who are increasingly dependent on technology, in particular the smartphone, and this phenomenon can even lead to limiting situations in which the person’s physical well-being is called into question. Intensive use of the smartphone may contribute to a decrease in physical activity and generate musculoskeletal symptoms (MMS).

Objectives

To verify the existence of a relationship between the use of the smartphone and: 1) MMS; 2) vigorous, moderate and sedentary physical activity

Methods

An observational, analytical, cross-sectional study was conducted on a sample of 834 adolescents from five schools in the regions of Viseu, Vila Real and Porto. Data collection was performed through online questionnaires through the Qualtrics program, in order to perform the sociodemographic characterization of the sample and to determine behavioral habits related to health, as well as to the use of new technologies. Musculoskeletal symptoms were evaluated through the Portuguese version of the Nordic musculoskeletal questionnaire. (NMQ) and physical activity through the International Questionnaire of Physical Activity (IPAQ).

Results

The adolescents who used the smartphone for the most time referred MMS in the cervical (p < 0.001), thoracic (p = 0.017), lumbar (p < 0.001), shoulders (p < 0.001), wrists/hands (p = 0.003) and knees (p = 0.013). Adolescents who practice more vigorous physical activity (p = 0.023) use less smartphone, and those who have more time in sedentary physical activity (p = 0.008) use it more.

Conclusions

Adolescents who spend more time on smartphones refer more MMS. The use of the smartphone is associated with a more sedentary lifestyle, unlike the adolescents who practice vigorous physical activity that give less use to it.

Correspondence: Jorge Bravo (jorgebravo@uevora.pt)

Background

Actual research reinforces the importance of multimodal exercise programs for fall prevention; however remains unclear which components should be included in exercise programs, considering physical and cognitive components.

63 males and 124 females (65-96 years) were selected based on the criteria of moderate or high functional independency (≥18 points) determined by responses to the 12-item of Composite Physical Functioning Scale [1]. FF was assessed by the Senior Fitness Test Battery [2]. A composite Z-score was created based on the individual scores for each fitness item. CP was assessed by the Mini-mental State Examination adapted for the Portuguese population [3]. Descriptive statistics were calculated for all outcome measurements and comparisons were performed using independent sample t-Tests. Multiple regression analyses were performed to test associations between FF and CP.

Results

T-test comparisons showed that females were more flexible than males (p < 0.05). Males were taller and heavier than females (p < 0.05). No differences were observed between these independent fallers and non-fallers sample. Multiple regression analyses were performed to understand the association of FF with CP in fallers and non-fallers. Agility was negatively associated with the MMSE score in fallers and non-fallers; however, after adjusting for gender, age and education, this association was not significant for non-fallers (p < 0.05). Lower body strength showed positive associations (p < 0.05) with the MMSE score exclusively in non-fallers, regardless the adjustments. Likewise, the upper body strength was positively associated with the MMSE score (p < 0.05) in non-fallers after adjusting for age, gender and education (p < 0.05). On the other hand, the upper body flexibility showed negative associations with the MMSE score (p < 0.05) however this association did not remain significant after adjusting for gender, age and education.

Conclusions

Independent older adults with higher agility scores were more likely to have an improved CP, whether they are fallers or non-fallers. Body strength, particularly improved lower body strength, is associated with higher CP in non-faller older adults, independently of age, gender and education. This exploratory study increases the spectrum of research in multimodal programs by suggesting that agility and strength training should be included in exercise prescription for fall prevention, in order to foment CP.

O7 Association between endurance of the trunk extensor muscles and the risk of falling in community-dwelling older adults

Sofia Flora, Ana Tavares, Joana Ferreira, Nuno Morais

Correspondence: Sofia Flora (sofiiaflora@gmail.com)

Background

Falls in the elderly are a serious health problem and the result of the complex interaction between individual and environmental risk factors. Balance is considered a key factor for higher falling risk in this population [1, 2]; thus, assessment and preventive/rehabilitation programs targeting the balance control system are currently a clinical guideline [1]. Programs commonly include strength/power training of the lower limbs and trunk muscles and postural control exercises [1, 3]. Recently it has been shown that the elderly reach premature muscle fatigue during upright stance tasks [2], and that fatigue leads to poor balance control [4]. Muscular endurance hence appears to play an important role in the efficiency of the balance control system, particularly during performance of long lasting functional tasks. However, the association between muscle endurance and balance control measures has been overlooked, especially in the trunk muscles, despite its potential to assist clinicians and researchers to comprehensively screen falling risk factors and tailoring interventions accordingly.

Objective

The main purpose of this cross-sectional study was to determine the association between endurance of the trunk extensor muscles and the risk of falls in the elderly, considering possible co-factors such as age and BMI.

Methods

Community-dwelling adults ≥ 65 years were recruited from senior universities in the Centre region of Portugal. Exclusion criteria included severe physical/cognitive limitations that would prevent subjects from performing the testing protocol. Falling risk/balance was assessed using the Berg Balance Scale (BBS, score 0–56). Muscle performance was measured through the trunk extensor endurance test (in seconds). Simple and multiple linear regression analyses, using SPSS (v20), were conducted to predict the effects of muscle endurance, BMI and age on balance control. Statistical significance was set at 0.05.

Endurance of the trunk extensor muscles and BMI predicted approximately 16% of the BBS score. Since these are modifiable factors, it is recommended that they should be routinely included in the screening of falling risk factors in the elderly and addressed accordingly in preventive programs.

Correspondence: Cristina Jácome (cristinajacome@ua.pt)

Background

To optimize a patient-oriented approach in asthma management, health professionals need to consider all aspects of the patient’s actual context (physical, social and attitudinal). This context can be assessed using the Environmental Factors component of the International Classification of Functioning, Disability and Health (ICF) Core Set for Obstructive Pulmonary Diseases (OPD). The categories included in the Environmental factors component have been selected by respiratory experts, and have been validated from the perspective of physicians, physiotherapists and patients with chronic obstructive pulmonary disease. However, the validation from the perspective of patients with asthma will be essential to allow a more widespread application of the ICF in this population.

Objective

This study aimed to validate the Environmental factors component of the Comprehensive and Brief versions of ICF Core Set for OPD from the perspective of patients with asthma.

Methods

A cross-sectional qualitative study was conducted with outpatients with asthma using semi-structured individual interviews. Qualitative data were analysed through the meaning condensation procedure by two researchers with expertise in the ICF.

Results

Thirty-five participants (26 females; 41±13 years) were included. Eight (35%) categories contained in the Environmental factors component of the Comprehensive version of the ICF Core Set for OPD and 4 (100%) of those contained in the Brief version were confirmed by the participants. Additionally, 5 second level categories (Products and technology for employment; Flora and fauna; Natural environment and human-made changes to environment, unspecified; Domesticated animals; Support and relationships, unspecified) and 13 third level categories (Food; Drugs; General products and technology for personal use in daily living; General products and technology for employment; Assistive products and technology for employment; Design, construction and building products and technology for gaining access to facilities in buildings for private use; Plants; Animals; Temperature; Humidity; Indoor air quality; Outdoor air quality; Health services) not included in the Core Set were identified.

Conclusions

The Environmental factors component of the Brief ICF Core Set for OPD was fully supported by the perspective of patients with asthma, contrasting with only one third of the categories of the Comprehensive version. The categories included in the ICF Core Set that were not confirmed by the participants and the additional categories that were raised need to be further investigated in order to develop an instrument tailored to patients’ needs. This will promote more patient-centred assessments and rehabilitation interventions.

Sónia C Simões1,2, Vanessa Vieira1, Mariana Marques1, Laura Lemos1

Correspondence: Sónia C Simões (soniasimoes@ismt.pt)

Background

Currently, to our knowledge, there is no research with Portuguese samples comparing the levels of attachment, self-compassion and psychopathological symptoms in subjects who use and do not use the Internet to establish intimate relationships.

Objective

The present study aimed to investigate how individuals, who use the Internet to establish intimate relationships, differ psychologically from individuals who do not use the Internet for this purpose.

Methods

We used the following scales: Experiences in Close Relationships (ERP), Self-Compassion Scale (SELFCS), Brief Symptom Inventory (BSI) and a short sociodemographic questionnaire. The sample consisted of 350 individuals of whom 284 used social networks to establish intimate relationships (I) and 66 did not use the Internet for this purpose (NI), with a mean age of 29.90 (SD = 7.41) for the I group and 30.72 (SD = 8.26) for the NI group. The majority of the sample was single in both groups (I: 83.5% vs. NI: 68.2%), heterosexual (I: 79.6% vs. NU: 93.9%), was attending or attended Higher Education (I: 66.5% vs. NI: 60.6%).

Results

We found that man used more, compared to woman, the Internet to establish intimate relationships, and that the individuals that used most the Internet for this purpose had a higher number of short-term intimate relationships, compared to the group of subjects that did not use the Internet for this purpose. We also found that individuals without a romantic relationship (single, separated/divorced or widowed) were who resorted to this type of online service. Differences between groups regarding attachment, self-compassion and psychopathology were not found. However, it is important to highlight the stronger associations between psychopathological symptoms (global severity index and BSI dimensions) with attachment and self-compassion in the group that did not use the Internet to establish intimate relationships, comparing to the group that reported using the Internet with this intention.

Conclusions

The results show the importance of deepening the research about the use of Internet to establish intimate relationships, since there are no studies concerning this area in Portugal.

Correspondence: Sónia C Simões (soniasimoes@ismt.pt)

Background

Alexithymia has been reported more significantly in subjects with obsessive-compulsive disorder (OCD), since they have a hard time recognizing and describing their own emotions. It should also be noted that many individuals with OCD often report experiencing traumatic situations. However, to our knowledge there are no Portuguese studies on the relationship between OCD (or obsessive-compulsive symptomatology), traumatic experiences, and alexithymia, justifying the relevance of this study.

Objective

The following goals were outlined: 1) To study the relationship between psychopathological symptoms, alexithymia and traumatic experiences in clinical and non-clinical samples; 2) To study and compare the traumatic experiences, the levels of alexithymia, and the psychopathological symptoms in clinical and non-clinical samples; 3) Check the relations of variables such as age, gender, marital status, and literacy with the presence or absence of obsessive-compulsive symptomatology in order to identify potential confounding factors.

Methods

The total sample comprised 115 individuals aged between 18 and 64 years (M = 31.50; SD = 10.61). For the creation of the 2 groups in comparison, the Maudsley Obsessive Compulsive Inventory (MOCI) cut-off point was used, in which results above 10 indicated the presence of obsessive-compulsive symptomatology. The clinical group had 40 subjects, aged between 18 and 49 years (M = 27.03; SD = 7.68) and the nonclinical group had 75 subjects, aged between 18 and 60 years (M = 33.89; SD = 11.21). The research protocol included: MOCI, Traumatic Experiences Checklist (TEC), Toronto Alexithymia Scale and the Brief Symptom Inventory.

Results

The clinical sample presented more psychopathological symptomatology and higher values of alexithymia compared to the non-clinical sample. No differences were found between groups in the presence of traumatic experiences, but the clinical sample presented higher scores of sexual abuse and trauma in the family of origin. Finally, there was a greater number of statistically significant associations and of a stronger magnitude in the non-clinical sample among the studied variables, compared to the clinical sample, especially according to the TEC.

Conclusions

It was verified that traumatic experiences and alexithymia, in particular, might be factors associated with the onset of obsessive-compulsive symptomatology, being a future study area to understand if they will also be risk factors for developing OCD.

Correspondence: João MG Frade (joao.frade@ipleiria.pt)

Background

Vaccination coverage rates higher than 95% contribute to the so-called group immunity effect with regard to measles vaccination [1]. However, to guarantee such immunity, it is important that those vaccine coverage rates also correspond to levels of seropositivity of measles antibodies (specific IgG antibodies levels > 150 mIU/ml) higher than 95% [2].

Objective

This study intends to evaluate from which moment, after having been vaccinated with MMR II (triple viral vaccine against mumps, measles and rubella), 95% of the individuals have specific IgG antibodies (Anti-Measles-IgG) <150 mIU/ml.

Methods

A cross-sectional study was conducted on 190 individuals, born in Portugal after 1990, with records of vaccine history documented in the Individual Record of Vaccination (IRV) and in the Individual Health Bulletin (IHB). Specific IgG antibodies to measles virus (Anti-Measles-IgG) were measured using the commercial immunoassay Siemens Enzygnost®Anti-Measles Virus/IgG.

Results

Data were grouped into three birth cohorts: born between 1990 and 1993, born between 1994 and 1995 and born between 2001 and 2004. It was found that those born between 2001 and 2004 were those that presented the highest levels of protection against measles, less than 2% of these individuals had levels of protection below the 150 mIU /ml. The cohort born between 1994 and 1995 was the one that presented the lowest protection against the disease, in which more than 50% of the individuals were below the protection threshold (150 mIU/ml). The cohort born between 1990 and 1993 is an intermediate cohort, where more than 50% of individuals are above protection threshold, but with a significant percentage of seronegative individuals. ANOVA analysis and Tukey's multiple comparison analysis showed a statistically significant difference among the 3 birth cohorts (p < 0.001). The use of mathematical modelling showed that at the end of 9 years, after individuals have received MMR II, more than 95% individuals no longer presented specific IgG antibodies against measles virus (Anti-Measles-IgG) above 150 mUI/ml (p < 0.0001).

Conclusions

The time elapsed since the last MMR II vaccination seems to be associated with protection against measles. Nine years after MMR II, more than 95% of individuals are seronegative for the Specific IgG antibodies to measles virus.

Correspondence: Leonel Preto (leonelpreto@ipb.pt)

Background

Fibrinolysis reduces mortality and disability after an ischemic stroke, and its benefits are documented with level of evidence I [1]. The major goal of the Code Stroke (CS) is to treat the eligible cases by fibrinolysis, within the therapeutic window of 4.5 hours after symptom onset [2]. Thus, an emergency department must operate efficient mechanisms to receive, diagnose, treat or transfer patients with stroke [3].

Objective

The main objective was to evaluate the results of the CS protocol implementation in an Emergency Department (ED) of a hospital in the North of Portugal. As secondary objectives we aimed to: (I) Characterize the patients in sociodemographic and clinical variables; (II) Calculate the activation rate of CS protocol and the rate of fibrinolysis.

Methods

Retrospective descriptive analysis, using data from the Manchester triage system and other secondary source of information, of all patients with ischemic stroke, haemorrhagic stroke, and transient ischemic attack (TIA) admitted to the Emergency Department between January 1, 2010 and December 31, 2016. Socio-demographic data, care times, cardiovascular risk factors and other clinical variables were collected. The statistical analysis was performed by ANOVA, at 0.05 significance level.

Results

In the 7 years analysed, 1200 patients with cerebrovascular disease were admitted in the ED. Among these patients, 63.0% presented ischemic stroke, 17.3% haemorrhagic stroke and 19.8% TIA. The population was predominantly male (54.8%) and had a mean age of 77.4 (± 11.2) years. Stroke code was activated 431 times, covering 37.2% (n = 282) of ischemic stroke, and have received thrombolytic therapy 18.4% (n = 52) of these patients. Door-to-needle time was, in average, 69.5 minutes. Mean (± SD) NIHSS (National Institutes of Health Stroke Scale) score was 14.8 (± 5.2) before treatment, decreasing to 11.8 (± 6.0) at two hours post- fibrinolysis (p < 0.05). For all patients (N = 1,200), we obtained the following prevalence of risk factors: Hypertension (64.7%), dyslipidaemia (30.3%), diabetes (26.5%), atrial fibrillation 23.3%), obesity (12.9%), smoking (6.3%) and ischemic heart disease (5.9%). The 24-hour mortality rate was 0.9% for ischemic stroke, 10.6% for haemorrhagic stroke, and 0% for TIA.

Conclusions

High rates of activation protocol were obtained for acute ischemic stroke, but only 52 patients met the criteria for fibrinolysis. The high age and comorbidity of patients with ischemic disease and its origin, predominantly rural, may have influenced the therapeutic window and the eligibility criteria for fibrinolysis.

O13 SEMantic and PRAgmatic assessment platform for school-age children

Dulce Tavares, Eileen S Kay

Escola Superior de Saúde de Alcoitão, 2649-506 Alcabideche, Portugal

Correspondence: Dulce Tavares (mdtavares@essa.pt)

Background

Semantic and pragmatic skills are developed throughout life and are essential in the development of school and social learning. Upon entering school, learning to read and write is developed in two large areas of knowledge. The first implies capacities of recognition and decoding of written symbols of the word and vocabulary development and the second allows the understanding of what is read through inferential capacities and non-literal interpretation. Often, students with reading comprehension difficulties go unnoticed. It is easier to detect a child who reads slowly, syllable by syllable, or with mistakes than those who read fluently but without understanding the content. These difficulties only become evident when questions are asked about the text and when it is necessary to understand the questions of subjects such as mathematics or science. Thus, success to reach the National Curricular Plan can be compromised.

Methods

Material was developed to evaluate semantic and pragmatic skills in school-aged children. In semantics, aspects of syntagmatic and paradigmatic relations (lexical field, synonymy and antonyms) and paronymy are evaluated. In pragmatics, competences are evaluated such as inferences, comprehension of idioms and proverbs. This material will be placed on a platform that can be consulted and used by different professionals working with children. The items that constitute this material took into account the stages of language development and school level. The lexicon used is in the domain of European Portuguese.

Results

The 756 children who were assessed attended public and private schools in Portugal. The results show an increasing evolution of the lexical competences of the children, with significant differences between the different age groups in all tests. There were no significant differences between female and male except in the paronym test. Regarding the socio-professional level of the child's origin, it is verified that it is a differentiating factor of lexical competence because significant differences in all tests were observed regardless of the age of the child.

Conclusions

The authors concluded that it is of great importance to analyse lexical competence regarding the aspects of its organization, as it enables students to deal with academic tasks successfully, improving literacy as well as to be able to act in a systematic and productive way in the intervention with children with language disorders. The complexity and innovation of the pragmatic skills assessment (in European Portuguese) leads to this work to continue in development.

Keywords

Semantic, Pragmatics, Assessment, School age.

O14 Quality of Life in Portugal – what factors can determine the QoL in people with Intellectual Disabilities and a great need of supports?

António Rodrigo, Sofia Santos, Fernando Gomes

Correspondence: António Rodrigo (antoniorodrigo92@gmail.com)

Background

In Portugal, the Quality of Life (QoL) concept has become increasingly relevant, leaving aside a vision that only focus on the person’s limitations to one that emphasizes the quality of interactions between personal characteristics and environmental demands, within a socioecological model. This new paradigm changes the approach to evaluation and planning individualized supports, regarding adults with Intellectual and Developmental Disability (IDD). Research shows an emerging interest in analysing what personal and environmental factors have impact in QoL of persons with IDD. Therefore, our main goal is to analyse how individual characteristics influence QoL of people with intellectual disability with greater need of supports.

Methods

The Portuguese version of the Escala San Martín, that focus on 8 QoL domains: Self-determination, Emotional Well-Being, Physical Well-Being, Material Well-Being, Rights, Personal Development, Social Inclusion and Interpersonal Relations was applied to 293 individuals with intellectual disabilities, over 18 years-old (32.31 ± 8.29), 128 females and 165 males. All participants were institutionalized. The dependent variables were the domains/QoL total scores and the independent variables were gender, diagnosis, age, comorbidities and tacking medication. A comparative study was carried out using either independent samples t-tests or the one-way analyses of variance (ANOVA).

Results

When comparing gender, age and medication consumption, no significant differences were found, with all groups presenting similar mean QoL scores. Regarding comorbidities, significant differences were found when comparing physical well-being (p < 0.001), rights (p < 0.001) and social inclusion (p = 0.001) domains, with higher mean QoL scores to those without comorbidities. Significant differences were also found regarding diagnosis, in all domains except for the material well-being. Higher mean scores were found in individuals with a mild intellectual disability diagnosis, when compared to those with severe or profound ID diagnosis.

Conclusions

The information about personal factors with impact in QoL will help to meet challenges and will allow a more adjusted person-centred planning. Discussion and implications for practice will be presented.

O15 Relationship between the levels of functional capacity and family functionality and depression in the elderly

Andréia WB Silva, Akemi Izumi, Giovanna G Vietta, Márcia R Kretzer

Correspondence: Andréia WB Silva (andreiawb@hotmail.com)

Background

Depression is one of the most prevalent mental health problems among the elderly [1]. Functional limitations and changes in family dynamics characterize important risk factors for the onset of depression [1,2].

Objective

To analyse the relation between levels of functional capacity and family functionality and depression in the elderly.

Methods

A cross-sectional study was conducted including one hundred and thirty-eight (138) elderly individuals. The presence of depression, the levels of capacity to perform Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) and family functionality were assessed, respectively, by the Geriatric Depression Scale (GDS), Katz Index of Independence in Activities of Daily Living, Lawton Scale and family APGAR. The Statistical Package for Social Sciences (SPSS) version 18.0 was used to enter and analyse data (p < 0.05). The present study was approved by the Research Ethics Committee of UNISUL.

Results

The most prevalent characteristics were the age between 60 and 69 years (62.3%), the female gender (52.9%), the white ethnicity (87.0%), having accomplished up to 8 years of schooling (75.8%), and being retired (80.4%). 67.4% of the elderly did not have a spouse, and 14.5% lived alone. Depression presented a prevalence in 43.5% of the participants, of whom 88.3% were mildly depressive and 11.7% were severely depressive. There was a high frequency of hypertension (64.5%), Diabetes Mellitus (37.7%), osteoarthritis (39.1%), heart failure (28.3%), chronic obstructive pulmonary disease (15.9%) and asthma (9.4%). When evaluating functional capacity, 1.4% and 12.3% of the participants were classified as dependent to perform BADL and IADL, respectively. Family dysfunction was observed in 12.3% of the elderly (5.1% moderate dysfunction and 7.2% high dysfunction). When testing associations between depression and sociodemographic characteristics, the results showed statistical differences when comparing gender and marital status. Women were 1,538 times more likely to have depression than men (p = 0.031), and individuals who had a spouse were 1,580 times more likely to suffer from the disease (p = 0.018). When associating depression with other comorbidities, arterial hypertension was 1.652 times more prevalent (p = 0.024). Statistical differences were also identified with heart failure (PR = 1.941, p = 0.001) and asthma (PR = 1.923, p = 0.012). The functional capacity for BADL and IADL did not differ statistically. Family dysfunction was significantly associated with depression, which was 1,969 times more frequent in dysfunctional families (p = 0.003).

Conclusions

Depression in the elderly is associated with the female gender, having a spouse, cardiovascular and respiratory morbidities and family dysfunction.

O16 Microbiological evaluation of hotel units swimming pools

Correspondence: Manuela Amorim (mas@ess.ipp.pt)

Background

Swimming pools are currently operated by public and private entities for the development of sports, recreational and therapeutic activities [1]. For this reason, it is essential to guarantee the chemical and microbiological quality of the pool water, since they may be the origin of several pathologies [2].

Objective

The present research aimed to analyse data from the microbiological evaluation of indoor and outdoor swimming pool waters of Hotel Units of Mainland Portugal and Madeira in the year 2016, in order to verify the water quality.

Methods

A cross-sectional descriptive study was performed using database records from a northern laboratory. The microbiological parameters studied to characterize the indoor and outdoor swimming pool waters included CFU/mL of viable microorganisms at 37ºC/24h, CFU/100mL of total coliforms, CFU/100mL of Escherichia coli, CFU/100mL of Enterococcus spp., CFU/100mL of Pseudomonas aeruginosa, CFU/100mL of total Staphylococcus and CFU/100mL of coagulase producers Staphylococcus. The samples were characterized as conforming and non-conforming according to the reference intervals indicated in Regulatory Circular nº 14/DA of 21/08/2009 of Direção Geral de Saúde [1].

Results

Of the total of indoor pools (n = 610) analysed, 25.09% (n = 153) were classified as non-conforming, being the microorganisms viable at 37 ºC the most frequent cause of nonconformities (n = 105), followed by total coliforms and total Staphylococcus (n = 42 each). For the outdoor pools (n = 1982), 29.92% (n = 593) were also classified as non-conforming, once more being microorganisms viable at 37 ºC the most frequent cause of nonconformities (n = 420), followed by total coliforms (n = 154).

Conclusions

Indoor swimming pools have a lower frequency of nonconformities compared to outdoor swimming pools. The ambient temperature and the presence of soils around the pool influence the microbiological quality of the water [2]. These results also suggest that water treatment is not effective, indicating water pollution, being hygienic care other factor that influence the microbiological quality of the water [3]. The determination of these parameters is useful when microbiological monitoring is carried out constantly.

O17 Normative values of functionality and quality of life of the portuguese healthy older people

Cátia Paixão1, Sara Almeida1,2, Alda Marques1,2

1Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; 2Institute for Research in Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Alda Marques (amarques@ua.pt)

Background

The older population is increasing worldwide [1]. Since the average life expectancy is currently 71.4 years at birth and the healthy life expectancy is only 63.1 years, there is a need to enhance the focus on public health to promote health and healthy ageing [2, 3]. Measures of functionality and health-related quality of life (HRQoL) have been identified as predictors of healthy aging [4-6]. However, to interpret results from those measures, and compare them within a population or across populations, normative data are necessary [7-9].

Objective

To establish age and gender-related normative values for the Five Times Sit to Stand Test (5 STS), 10 Meter Walk Test (10MWT), and World Health Organization Quality of Life-Bref (WHOQoL-Bref) for Portuguese healthy older people.

Methods

An exploratory cross-sectional study was conducted. Participants were recruited from the community. Functionality was assessed with the 5STS [4, 10] and 10MWT [5, 11] and Health-related Quality of Life (HRQoL) with the WHOQoL-Bref (scores: 0-20 and 0-100) [6]. Descriptive statistics was used to determine normative scores by age decades (60-69; 70-79; 80-89 years) and gender. Differences between age and gender were explored with multiple comparison tests using the Bonferroni correction.

This study provided normative values of 5STS, 10MWT and WHOQoL-Bref for the Portuguese healthy older people. These data may improve the utility of these measures for health professionals to screen people and develop tailored interventions to improve functionality and HRQoL in this population. Normative values of WHOQoL-Bref will also allow identifying vulnerable groups and describing the profile of HRQoL in Portuguese healthy older people living in the community.

Acknowledgements

This work was partial supported by Programa Operacional de Competitividade e Internacionalização (COMPETE), through Fundo Europeu de Desenvolvimento Regional (FEDER) and Fundação para a Ciência e Tecnologia (FCT) under the project UID/BIM/04501/2013.

O18 Relationship between balance and functionality, gait speed, physical activity and quality of life in community-dwelling older people

Sara Almeida1,2, Cátia Paixão1, Alda Marques1,2

1Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; 2Institute for Research in Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Alda Marques (amarques@ua.pt)

Background

Balance is a modifiable risk factor for falls which represent a major public health problem for healthy ageing [1]. Predictors of healthy ageing in older people (i.e., functionality, gait speed, physical activity (PA) and health-related quality of life (HRQoL)) have been correlated with balance measures [2-5]. However, most balance measures do not assess the different components of balance hindering the design of interventions. To overcome this difficulty the Balance Evaluation System Test (BESTest) [6] and its short versions [7, 8] (new comprehensive measures of balance) were developed. Nevertheless, the relationship between the BESTest [6] and its short versions [7, 8] with functionality, gait speed, physical activity and health-related quality of life older people living in the community is still unknown.

Objective

To explore the relationship between the BESTest, Mini-BESTest and Brief-BESTest with functionality, gait speed, PA and HRQoL in community-dwelling older people.

Methods

An exploratory cross-sectional study was conducted. Community-dwelling older people (> 60 yrs) were recruited. Balance was assessed with the BESTest, Mini-BESTest and Brief-BESTest, functionality with the 5STS [9], gait speed with the 10MWT [10], PA with the Brief-PA questionnaire [11] and HRQoL with the WHOQoL-Bref [12]. Descriptive statistics was used to characterize the sample. Correlations were explored with the Spearman correlation coefficient. By convention, the interpreting size of a correlation coefficient was negligible (0.00-0.30), low (0.30-0.50), moderate (0.50-0.70), high (0.70-0.90) and very high (0.90-1.00) correlation [13].

This study shows that there is a relationship between the BESTest and its short versions with functionality, gait speed and HRQoL in community-dwelling older people. Higher correlations were found in the short versions, especially with functionality measures. This is useful for clinical practice since these versions are simpler, require less material and are quicker to apply.

Acknowledgements

This work was partial supported by Programa Operacional de Competitividade e Internacionalização (COMPETE), through Funfo Europeu de Desenvolvimento Regional (FEDER) and Fundação para a Ciência e a Tecnologia (FCT) under the project UID/BIM/04501/2013.

5. Nilsagård Y AM, Carling A, Vesterlin H. Examining the validity and sensitivity to change of the 5 and 10 sit-to-stand tests in people with multiple sclerosis. Physiotherapy Research International. 2017;22(4):e1681.

O19 Trends of hospitalization for chronic obstructive pulmonary disease in Brazil from 1998 to 2016

Correspondence: Bárbara O Gama (barbara.oenning@hotmail.com)

Background

Chronic Obstructive Pulmonary Disease (COPD) is a major public health problem. In Brazil, it is the fifth largest cause of hospitalization in the public health system when analysing patients over 40 years of age.

Objective

To analyse the trend of hospitalization for COPD in Brazil from 1998 to 2016.

Methods

Trend analysis of hospitalization for COPD were based on data from the “Sistema de Informação Hospitalar do Departamento de Informática do Sistema Único de Saúde” (DATASUS). Simple linear regression analysis, p < 0.05. Approved by the Ethics Committee of the Universidade do Sul de Santa Catarina (UNISUL).

Results

In the period, 3,403,536 hospitalizations for COPD were analysed in Brazil, with a strong tendency to reduce rates (β= -6,257, p < 0.001), from 166.2/100,000 inhabitants in 1998 to 56.7/100,000 inhabitants in 2016. Among the Brazilian regions, there were higher hospitalization rates in the southern region, 461.8/100,000 inhabitants in 1998 and 133.1/100,000 inhabitants in 2016, followed by the central-west region, 222.2/100,000 inhabitants for 61,6/100,000 inhabitants. The region with the lowest rates of hospitalization was the northeast, with 69.6/100,000 inhabitants at 36.7/100,000 inhabitants. There largest decreases in the southern region (β= -19.4). The trend is decreasing in both sexes, with the largest reduction in male (β = -6,976), which has the highest admission rates at the beginning and end of the period (180.7 and 60.6/100.000 inhabitants, respectively). All age groups analysed showed a significant reduction tendency, with the largest decreases in the age groups above 60 years. In the age group of 80 years or more, there was reduction from 3370.1/100,000 in 1998 to 1535.3/100,000 inhabitants in 2016 (β = -101,198). In females, the reduction was from 2089.1/100,000 inhabitants to 548.4/100,000 inhabitants (β = -84,372).

Conclusions

The trend of hospitalization for COPD in Brazil is decreasing. The southern region has the highest rates, as does the male sex. The age groups of 60 and older in both sexes present the highest rates of hospitalization, with increase proportional to the increase in age. The results indicate a change in the profile of this disease, which can be attributed to a greater coverage of the family health strategy, better monitoring of diagnosed cases, and free access to medicines dispensed by the SUS (Sistema Único de Saúde), which reduce exacerbations of the cases.

Keywords

Chronic Obstructive Pulmonary Disease, Hospitalization, Trends.

O20 Temporal trend of hospitalization for acute myocardial infarction in the southern Brazilian states from 2008 to 2016

Correspondence: Jessica M Okabe (jessica.okabe@gmail.com)

Acute Myocardial Infarction (AMI) is responsible for high hospitalization rates in Brazil Southern regions and represents one of the major causes of morbidity and mortality.

Objective

To analyse the temporal trend of hospitalization for AMI in the southern Brazilian states from 2008 to 2016.

Methods

Ecological study of time series of hospitalization for AMI, with data from the Hospital Information System provided by the Department of Informatics of the Single System (CID 10 - code I 21.9) in the resident population of the States of Paraná (PR), Santa Catarina (SC) and Rio Grande do Sul (RS), according to sex and age group. Simple linear regression was performed, with p < 0.05. Study approved by the Research Ethics Committee of the Southern University of Santa Catarina.

Results

In the analysed period, there were 154,828 hospitalizations in the South region. There was an upward trend in rates, with an average annual increase of 4,261 hospitalizations per AMI/100,000 inhabitants. At the beginning of the period a rate of 82.65/100,000 inhabitants was registered and at the end a rate of 118.67/100,000 inhabitants. The same trend was observed in the three southern states. Paraná presented a rate of 15.57/100,000 in 2008, to 24.89/100,000 in 2016 (β = 1.064; p = 0.002). In Santa Catarina the rate ranged from 17.11/100,000 in 2008 to 28.23/100,000 in 2016 (β = 1.159; p < 0.001). Rio Grande do Sul presented the highest rates among states, from 21.98/100,000 in 2008 to 30.57/100,000 in 2016 (β = 1.156; p < 0.001). Both sexes had an upward trend (male β = 15.732; p < 0.001; female β = 8.553; p < 0.001), with a variation from 279.32 (2008) to 418.46/100,000 inhabitants (2016) among men; and from 165.76 to 238.05/100,000 inhabitants among women. It was observed that the age groups between 40-49 years and 70-79 years, in both sexes, presented an upward tendency of hospitalization rates. In the male age group between 40 and 49 years, the increase in hospitalization rate was 368.56/100,000 in 2008 to 475.21/100,000 in 2016 (β = 10.553; p = 0.01). Between 70-79 years there was an increase of 10791.40/100,000 to 12458.46/100,000 in this same period (β = 160.084; p = 0.04). In the female age group between 40-49 years the increase in hospitalization rate was from 168.11/100,000 in 2008 to 210.63/100,000 in 2016 (β = 5.184; p = 0.02). And between 70-79 years there was an increase from 4452.09/100,000 to 5130.12/100,000 in this same period (β = 78.868; p = 0.02).

Conclusions

The study showed an upward trend in hospitalization rates for AMI in the Southern Region, by sex and age groups above 30 years for both sexes. Males present the highest rates.

Keywords

Acute myocardial infarction, Trend, Hospitalization.

O21 Temporal trend of the incidence of tuberculosis in the state of Santa Catarina from 2001 to 2015

Correspondence: Rafaela F Abreu (rafaelafujii@hotmail.com)

World Health Organization (WHO) declared Tuberculosis (TB) as a global public health emergency. TB control is a priority in Brazil.

Objective

To analyse the temporal trend of incidence of Tuberculosis in the State of Santa Catarina from 2001 to 2015.

Methods

Ecological study of time series of TB incidence trends selected from the SINAN (Information System for Notifiable Diseases) of the Ministry of Health in the population residing in the State, by sex, age group and macro-regions. Simple linear regression was performed, p < 0.05. Study approved by the Research Ethics Committee of the Southern University of Santa Catarina.

Results

From 2001 to 2015, 30,213 TB cases were confirmed in Santa Catarina, with a steady trend in incidence rates, with 31.2/100,000 inhabitants in 2001 and 32.0/100,000 inhabitants in 2015 (p = 0.27). The male gender presented the highest rates, showing a strong tendency to increase, with an increase of 0.456 per year, ranging from 42.24/100,000 inhabitants in 2001 to 47.55/100,000 inhabitants, in the year 2015 (p < 0.001). In the male groups, aged from 0 to 19 years and from 20 to 29 years, a significant trend occurred in the increase of incidence rates, with an increase of 0.159 and 0.606, respectively, of the rate (p = 0.02) per year. The age group from 40 to 49 years, in turn, showed a decreasing trend, with a reduction of 1.292 in the incidence rate per year (p = 0.001). In females, there was a reduction of 0.802 in the rate per year in the age group of 20 to 29 years (p = 0.003). The macro-regions of the Midwest, Foz do Rio Itajaí and Plateau Norte presented a reduction in TB incidence rates. In the macro-regions of Greater Florianópolis and South, the trend was increasing (p < 0.05).

Conclusions

TB incidence rates in Santa Catarina are stationary. Growing trend in males. Growing trend in the male age groups up to 29 years and decreasing between 40 and 49 years. Decreasing trend in the female age group from 20 to 29 years. Macro-regions located in the coastal range have an increasing tendency and the macro-regions located in the Centre West of the State, a decreasing trend.

O22 Trauma, impulsivity, suicidality and binge eating

Instituto Superior Miguel Torga, 3000-132 Coimbra, Portugal

Correspondence: Ana C Ribeiro (anaclaudia_aac@hotmail.com)

Background

Binge eating is a public health problem with physical and psychological effects, throughout life. Several studies explored the association between some variables (e.g. shame) and binge eating symptoms, but it is important to continue exploring the contribution of other correlates.

Objective

Explore the association and the predictive role of traumatic experiences, impulsivity and suicidality with/to binge eating symptoms.

Methods

421 subjects from the general population and college students (women, n = 300, 71.3%) completed the Traumatic Events Checklist, the Binge Eating Scale, the Barratt Impulsiveness Scale and the Suicidality Scale.

Results

The values of punctual prevalence of binge eating symptoms were similar to those from recent national studies, having found a severe severity of 2.6% in the total sample (3.3% in women). In both genders, suicidality total score and the body mass index (BMI) associated with binge eating total score. Only in women this score correlated with sexual and family trauma total scores and with the total score of traumatic events. If in men suicidality total score associated with family trauma total score and with the total score of traumatic events; in women that score also correlated with sexual trauma total score. In men, binge eating total score associated to attentional impulsivity (one of the first order impulsivity factors) and, in women, to all the first order impulsivity factors (attentional impulsivity, motor and non-planning), and with all the second order impulsivity factors (psychological attention, cognitive instability, motor, self-control and cognitive complexity), with the exception of perseverance. In women, attentional impulsivity particularly associated with sexual and family trauma total scores and with the total score of traumatic experiences. In women, the BMI, suicidality and attentional impulsivity total scores were the binge eating total score predictors.

Conclusions

In a sample from the general population and college students, we found that it is salient and of importance for future interventions, mainly in women, the predictive role of BMI, suicidality and attentional impulsivity scores to binge eating symptoms, with traumatic events (a more distal correlate) revealing significant associations, but not predicting these symptoms.

1Faculty of Sports, University of Porto, Porto,4200-450 Portugal; 2Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; 3Institute for Research in Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal; 4Pulmonology Department, Baixo Vouga Hospital Center, 3810-501 Aveiro, Portugal

Correspondence: Ana Oliveira (alao@ua.pt)

Background

Timely treatment and adequate monitoring of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have shown to reduce hospital admissions and recovery time, while improving patients’ quality of life [1]. Nevertheless, this is challenging as AECOPD diagnosis/monitoring relies exclusively on patients’ reports of symptoms worsening [2]. AECOPD are characterised by an increased airway inflammation and obstruction, abnormal bronchial mucus and air trapping, which results in changes in lung acoustics [2,3]. Thus, changes in respiratory mechanics related with AECOPD may be successfully monitored by respiratory sounds, namely adventitious respiratory sounds (ARS, crackles and wheezes) [3]. Nevertheless, little is known on ARS changes during the time course of AECOPD.

Objective

To evaluate ARS changes during the time course of AECOPD.

Methods

25 non-hospitalised patients with AECOPD (16 males, 70.0 ± 9.8yrs, FEV1 54.2 ± 20.6% predicted) were enrolled. Patients were treated with pharmacological therapy. ARS at anterior and posterior right/left chest were simultaneously recorded at hospital presentation (T1) and at weeks 3 (T3) and 8 (T8). ARS (no. of crackles and wheeze occupation rate–%Wh) were processed, per respiratory phase, using validated algorithms [4,5]. Differences were examined with Friedman and Cochran tests and both tests were corrected with Bonferroni corrections.

Results

Significant differences were found in no. of inspiratory crackles (0.6 [0.1-2.2] vs. 0.5 [0.1-2.5] vs. 0.3 [0.0-0.9]; p = 0.008) in T1, T3 and T8 at posterior chest, namely participants presented more inspiratory crackles (p = 0.013) at T1 than at T8. Similar results were found for inspiratory %Wh (0.0 [0.0-12.3] vs. 0.0 [0.0-0.0] vs. 0.0 [0.0-0.0]; p = 0.019), namely, participants presented significantly more inspiratory %Wh at T1 than at T3 (p = 0.006). A significant higher number of participants presenting inspiratory wheezes was found at T1 than at T3 at the anterior chest (%Wh: 10 vs. 2 vs. 5; p=0.017) and a trend to significance was found at posterior chest (%Wh: 10 vs. 3 vs. 4; p = 0.052). No differences were found for the remaining variables.

Conclusions

Crackles and wheezes seem to be sensitive to monitor the course of AECOPD. Inspiratory crackles seem to persist until 15 days after the exacerbations (i.e., approximate time needed to resolve AECOPD [6]) whilst inspiratory %Wh significantly decreased after this period. This information may allow further advances in the monitoring of patients with COPD across all clinical and non-clinical settings, as respiratory sounds are simple, non-invasive population-specific and available by nearly universally means. Further studies with larger samples and including data collected before the AECOPD are needed to confirm these findings.

O24 Trauma, self-disgust and binge eating

Instituto Superior Miguel Torga, 3000-132 Coimbra, Portugal

Correspondence: Sandra Soares (sandra.soares.93@hotmail.com)

Background

Binge eating disorder is finally recognized in the current Diagnostic and Statistical Manual of Mental Disorders-5. Additionally, international and national studies explored correlate binge eating symptoms, but it is important to evaluate the role of other variables for these symptoms, in the general population.

Objective

Explore the association and predictive role of traumatic experiences and of self-disgust with/in binge eating symptoms, exploring, also, the possible mediation role of self-disgust in the relation between traumatic experiences and those symptoms.

Methods

421 subjects from the general population and college students (women, n = 300, 71.3%) completed the Traumatic Events Checklist, the Binge Eating Scale and the Multidimensional Self-disgust scale.

Results

We found binge eating (BE) values similar to those from other national studies: mild to moderate BE (women: 6.3%; men: 5.0%) and severe BE (women: 3.3%; men: 0.8%). In men, BE total score positively correlated with defensive activation, cognitive-emotional and avoidance dimensions (self-disgust). Body mass index (BMI) positively correlated with BE total score and defensive activation (self-disgust) and negatively with family trauma. In women, BE total score positively associated with all self-disgust dimensions. Sexual trauma, family trauma, total of traumatic events and BMI positively associated with BE total score and all the self-disgust dimensions. In a hierarchical multiple regression analysis, BMI, total of traumatic events and the cognitive-emotional of self-disgust predicted BE total score. The cognitive-emotional (self-disgust) dimension mediated totally the relation between traumatic events and the BE total score.

Conclusions

In a sample from the general population and college students, BE values were similar to those from national studies. In women, sexual trauma, family trauma and total traumatic experiences (and all self-disgust dimensions) associated with BE. A higher BMI was associated with higher BE levels. In future interventions focusing on BE, in women, it seems important to consider the role of cognitive-emotional self-disgust in the relation between BE occurrence and distal traumatic events.

Correspondence: Marisa Lousada (marisalousada@ua.pt)

Background

Screening procedures do not identify the specific disorder but allow a quick identification of children who may need a detailed assessment in speech therapy. Screening instruments are usually performed by different health professionals (e.g. pediatricians, nurses). The Child Health Program for primary care in Portugal determined that all 5-year-old children should be screened by nurses and general practitioners to conclude if they present a typical development suitable to school requirements. This screening is usually implemented through the Mary Sheridan test and there is no speech-language screening test used in primary care. Recently a Speech and Language Screening was validated for Portuguese children in kindergartens with excellent levels of specificity, sensitivity and reliability. RALF aims to quickly identify (5 minutes) children who may be at risk of speech-language impairment and need to be referred to a in depth assessment by a Speech-Language Therapist.

Objectives

This study aims to implement a new screening procedure in primary health care contributing to best practices. Specifically, the study aims to identify children with speech-language disorder that are undiagnosed due to the absence of a known condition such as neurological, hearing or cognitive impairment.

Methods

Ethical approval was granted by the Ethics Committee (UICISA) (ref.14/2016). A sociocultural questionnaire characterizing child and family background was fulfilled by caregivers to collect information about the child’s background (e.g., mother language; neurological, hearing, cognitive disorder) and child’s family background. Subject selection criteria included: Portuguese as native language and absence of a language disorder secondary to a known condition. The sample comprised 37 children whose parents returned informed consents. The screening was applied by 10 nurses in the Global Health Examination of 5 years old children in 2 health care centres.

Results

Twenty-one percent of children failed the screening. This illustrates the high level of speech-language difficulties (without any other associated condition) and is consistent with previous research studies. The children that failed the screening were already been referred to speech-language services for a detailed assessment.

Conclusions

This study highlights the importance of the implementation of a screening procedure in primary health care contributing to best practices.

Correspondence: Henrique P Neiva (henriquepn@gmail.com)

Background

Several studies described the use of different sensors to detect the daily activity, movement and sleep patterns and physical activities [1]. These are easily available for all those who are interested in tracking physical activity and progresses to improve physical fitness and health-related parameters [1]. However, little is known about the people’s knowledge about this equipment and specially in some specific activities that have some restrictions, for instance those performed in-water.

Objective

The purpose of this study was to characterize Portuguese practices on the use of wearable technology during aquatic activities.

Methods

Swimming pools from the interior region of Portugal were selected randomly and their users completed a questionnaire consisting of 33 questions. The first part focused on the characterization of their motivations and usual in-water activities, and the second focused on their views on the value of the wearable technology, its use and suggestions for future development of those devices according to aquatic activities.

Results

Ten swimming pools were accessed, and 418 questionnaires were filled by people ranging from 18 to 79 years-old. About 79% of these subjects have heard about wearables for sport, but 65% never used them during exercise. At the time of the inquiries, 24% still used and 11% gave up using it mainly because of lack of interest or because the devices did not work well underwater. Among the non-users, most reported that they did not have the opportunity (53%), considering that they are not useful (17%), or complaining about the financial cost (15%). However, most of them (74%) would be interested in trying this type of equipment during aquatic activities. Interestingly, 71% did not consider doing more exercise after they have the equipment. From those subjects using wearables, only a few (n = 24) used during in-water exercise.

Conclusions

For future, the devices should be more comfortable, be more reliable, be water resistant, with longer battery life. Besides the usual feedbacks provided, they also would like to see some technical corrections evidenced by that technology. People seemed to know about the existence of wearables to monitor physical activity but are still reluctant because of their underwater reliability, cost, and opportunity to try them. These results evidenced a need for improving these technological devices according to subjects needs and the activities performed. Some suggestions were made according to the future development of these devices to use during in-water exercitation.

O27 Does the recall of caregiver eating messages exacerbate the pathogenic impact of shame on eating and weight-related difficulties?

Sara Oliveira, Cláudia Ferreira

Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, 3000-115 Coimbra, Portugal

Correspondence: Sara Oliveira (sara.oliveira.uc@gmail.com)

Background

It has been recognized the central role of caregiver eating messages - restriction of food intake and pressures to eat - on later individual's eating behaviour, body image and weight status [1-3]. Additionally, shame is a painful emotion [4] also associated with the development and maintenance of body image and eating-related difficulties [5, 6], namely inflexible eating and concerns and maladaptive attitudes regarding body weight and shape [7].

Objective

The main aim of the present study was to test whether recalling caregiver eating messages [3] moderates the association of external shame [8] with inflexible eating rules [7] and with concerns and maladaptive attitudes regarding body weight and shape [9,10].

Methods

The sample comprised 479 Portuguese women, aged between 18 and 60 (M = 25.66; SD = 8.50), who completed validated self-report measures. The relationship between the study variables was accessed by Pearson product-moment correlation and the moderator effect was tested through path analysis.

Results

Results revealed that caregiver restrictive/critical messages played a significant moderator effect on the relationships of external shame with inflexible eating rules, and with concerns and maladaptive attitudes regarding body weight and shape. These findings suggested that caregiver restrictive/critical eating messages exacerbated the impact of shame on these psychopathological outcomes, with the tested model accounting for 17% and 29% of the variance of inflexible eating rules and body weight and shape concerns, respectively. In addition, pressure to eat caregiver messages was not correlated with all variables examined. A graphical representation of the moderation analyses allowed to understand that, for the same levels of external shame, women who recall more caregiver restrictive/critical eating messages tend to adopt more inflexible eating rules and present greater concerns and maladaptive attitudes regarding body weight and shape.

Conclusions

These findings appear to offer important clinical and investigational implications, highlighting the importance of the development of efficient parental intervention approaches as a refuge against maladaptive eating regulation strategies.

O28 How does shame mediate the link between a secure attachment and negative body attitudes in men?

Sara Oliveira, Cláudia Ferreira

Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, 3000-115 Coimbra, Portugal

Correspondence: Sara Oliveira (sara.oliveira.uc@gmail.com)

Background

Shame is a painful self-conscious and universal emotion [1] regarded as a central feature of the development and maintenance of body image difficulties [2]. Additionally, it’s known the association between attachment style and body concerns, among women [3]. Particularly, a secure attachment may promote a more favourable body image [4]. However, few studies have focused on mechanisms that may explain body image difficulties in men.

Objective

The present study tested a model which hypothesized that the impact of a secure attachment on the engagement in negative male body attitudes, namely attitudes towards their muscularity and body fat [5, 6], is carried by general feelings of shame [7], while controlling the effect of body mass index.

Methods

The sample comprised 133 men, aged between 18 and 60 years old (M = 28.83; SD = 10.24), who completed validated self-report measures. The relationship between the study variables was accessed by Pearson product-moment correlation and the mediator effect was conducted through path analysis.

Results

The tested path model explained 22% and 49% of negative male attitudes towards their muscularity’s and low body fat’s variance, respectively. Results demonstrated that a secure attachment presented a significant direct effect on attitudes towards body fat, and an indirect effect through external shame on attitudes towards muscularity. In fact, these findings seem to suggest that men who were secure in attachment tend to experience less general feelings of shame and, consequently, presented low negative body attitudes, namely in regards to their muscularity and body fat.

Conclusions

These data support the relevance of addressing shame experiences when working with men with body image related-difficulties, especially in a context of early adverse experiences in their attachment.

7. Matos M, Pinto-Gouveia J, Gilbert P, Duarte C, Figueiredo C. The Other As Shamer Scale – 2: Development and validation of a short version of a measure of external shame. Personal Individ Differ. 2015; 74:6–11. doi:10.1016/j.paid.2014.09.03.

Keywords

Secure attachment, External shame, Negative body attitudes, Men.

O29 Potential contamination of tourniquets used in peripheral venipuncture: preliminary results of a scoping review

Correspondence: João Graveto (jgraveto@esenfc.pt)

Background

Peripheral venipuncture constitutes one of the most frequent and invasive clinical procedures performed in healthcare settings [1-2]. In order to stop blood flow and promote vascular distension, the use of a tourniquet five to ten centimetres above the desired puncture site is recommended [3]. The irregular management of these specific medical devices, without complying with guidelines, constitutes a risk of microorganism dissemination [4-5].

Objective

To map the available evidence on the microbiological contamination of tourniquets used in peripheral venipuncture, identifying recurrent practices in their manipulation.

Methods

Scoping review based on the principles advocated by Joanna Briggs Institute [6]. The analysis of relevance of the articles, the extraction and synthesis of data was performed by two independent reviewers. The search strategy included all articles published until November 2017, written in Portuguese, Spanish, French and English.

Results

An initial total of 2,052 articles derived from the search conducted. Through Endnote software, 998 duplicates were removed. The remaining 1,054 articles were screened by title and abstract. Of these, 33 articles were included for full-text analysis by two independent reviewers. During this process, the reference lists of all included articles were screened, which resulted in the inclusion of 3 new articles. Ten studies were excluded due to absence of microbiological data inclusion and 6 were excluded due to lack of full-text access and author's reply. Overall, a total of 1,337 tourniquets belonging to nurses, nursing assistants, doctors, phlebotomists and lab workers were analysed for microorganism contamination. A small number of studies verified that the same tourniquets were used continuously by professionals between 3 days to 104 weeks. Preliminary results evidenced contamination rates varying between 9% and 100%, composed by diverse microorganisms such as Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Enterococcus and Acinteobacter baumannii. Several of the included studies described conflicting practices during tourniquet manipulation by health professionals, especially when focused on domains such as hand hygiene before and after tourniquet use, glove usage during venipuncture, tourniquet cleaning and disinfecting, sharing tourniquets with other professionals and storage conditions. The most cited reason for tourniquet replacement in clinical settings was due to their loss by health professionals.

Conclusions

As a contribution to clinical practice, it is expected that the mapping of the available scientific evidence regarding the potential contamination of these devices will appear as an informative contribution that supports the analysis of current practices in this field, promoting the implementation of quality assurance systems in health institutions.

Acknowledgements

This protocol is part of the project “Transfer of technological innovations to nursing practice: a contribution to the prevention of infections”, funded from the European Regional Development Fund, by the Operational Program Competitiveness and Internationalization of PORTUGAL 2020.

Correspondence: Romeu Mendes (romeuduartemendes@gmail.com)

Background

Peripheral Diabetes imposes an unacceptably high human, social and economic cost, especially on aging populations. Nutrition-related knowledge is of crucial importance to make healthier food choices, contributing for type 2 diabetes (T2D) control and related comorbidities prevention.

Objective

To analyse the effects of a food education program (FEP) on the nutrition-related knowledge (NRK) in middle-aged and older patients with T2D.

Methods

Forty-two individuals between 50 and 80 years old with T2D were recruited in primary health care institutions, to participate in Diabetes em Movimento®, a community-based exercise program (3 exercise sessions per week; 75 minutes each; during 9 months), developed in Vila Real, Portugal. Participants were randomized into two groups: a control group (CG; N = 19; exercise program only) and an experimental group (EG; N = 23; exercise program plus a FEP). The FEP was 16 weeks long and, on each week, a different nutrition-related theme was addressed. Each theme was driven through a theoretical session (15 minutes) and dual-task exercise strategies integrated in Diabetes em Movimento®'s sessions. The NRK was evaluated, before and after the 9-month intervention, using the Portuguese reduced version of Nutritional Knowledge Questionnaire (from 0 to 56 points; higher score, better knowledge).

A community-based easy-to-implement food education program was effective in increasing NRK of middle-aged and older patients with type 2 diabetes and may contribute to better food choices. Program's adherence levels play a major role on knowledge acquisition.

Correspondence: Rui S Cruz (ruic@estescoimbra.pt)

Background

Currently, drug therapy with oral antidiabetic agents, is capable of inducing normoglycemia levels able to decrease the risk of complications associated with diabetes mellitus. However, it is also known that the various existing oral antidiabetic agents may trigger a large number of adverse events, either alone or in combination. Some of these tolerability and security issues related to the oral antidiabetic are reported by patients and can influence negatively or satisfaction with treatment or glycaemic control, or the therapeutic adherence and maintenance. It is therefore very important the role of patients in monitoring adverse events related to the use of the oral antidiabetic drugs in order to optimize treatment and improve the quality of life of patients with type 2 diabetes (DM2).

Objective

The aim of this study was to determine the prevalence of adverse events associated with use of oral antidiabetics and assessing their impact on Health-related Quality of Life (HRQoL) of diabetic patients tracked in primary health care.

Methods

A total of 357 DM2 patients were enrolled in observational and cross-sectional study, recruited in six Health Care Centres/Family Health Units (FHU) of the central region of Portugal. Data collection comprised three questionnaires to measure the prevalence of adverse events, the diabetes health profile (DHP-18) and EQ-5D-3L.

Results

Results showed that the highest prevalence of adverse events is in the DipeptidylPeptidase-4 Inhibitors followed by Metformin+Sitagliptin (fixed dose) and Metformin+Vildagliptin (fixed dose) therapeutic classes. We also found that all correlations between different variables were statistically significant (p < 0.001).

Conclusions

Thus, we conclude that patients who show a greater number of adverse events tend to have poorer health profiles, worse general health and also lower health-related quality of life.

Correspondence: Joyce CS Camargo (joyce@usp.br)

Background

The placental-delivery, in waterbirth (WB), usually occurs while maternal wellbeing is monitored through clinical aspects, heart-rate and blood-pressure, as well as water-coloration. Adequate care should be taken in this period, with prevention of postpartum-haemorrhage(HPP), which is the main cause of maternal death in developing countries, and approximately ¼ of all maternal deaths worldwide [1].

Objective

To verify the outcome of the labour’s third stage at the Waterbirth-Project (PWB), in Setúbal, at São Bernardo’s Hospital located in Portugal. Study's question: What’s the maternal outcome of childbirth’s 3rd stage in PWB?

Methods

Observational-study, cross-sectional, descriptive based on ethical guidelines (CNPD-9885/2015) approved by the hospital, where delivery room’s infrastructure, protocol’s definition and technical and scientific training of the obstetric-team began in 2006. The PWB occurred between 2011-2014. 153 women, with a single pregnancy, gestational age ≥ 37 weeks with low-risk prenatal care participated in the PWB, signed an informed consent form about study’s benefits and risks, resulting in 90 waterbirths. Data were collected from the specific PWB forms in April 2016. Data management was developed in Excel® and SPSS® version 16.0 programs.

Results

In the PWB, 51.1% of women had placental waterbirth vs 48.9% out-of-water. The active management occurred in 7.7% vs 86.7% of physiological management, 92.3% of the women had physiological blood loss, and 7.7% had increased bleeding, controlled with uterotonics. These results corroborate with evidence: Swiss study [2], with 89 WB vs 279 out-of-water births, 57% had physiological defect in the water and the 3rd-Stage was significant (p < 0.01) in PA; English study [3] with 5,192 WB, with third physiological stage, 86.1% of which 55.8% were in water. For 3rd-Stage’s management [4]: 1. Active: administration of uterotonic (oxytocin [1], 1st choice) after birth, timely clamping of the umbilical cord and controlled cord traction. 2. Physiological: Spontaneous relief assisted by gravity and/or maternal effort. In order to evaluate PPH in WB, in addition to the clinical state of the puerperium, the coloration of the comparison to wine is analysed: 50-100 ml blood loss to the pink-Chablis; from 150-250 ml to bleed and 500-750 ml to Merlot-wine [5] or, study-site midwife’s puts-hand below the surface of the water horizontally. If visible hand, haemorrhage ≤ 500mL, if hand not-visible, haemorrhage > 500mL.

Conclusions

The 3rd-Stage’s management in WB is safe and according to the experience of the PWB, no adverse events were related to it. More studies are needed to support good clinical practices based on scientific evidence.

4. ICM, FIGO. Prevention and Treatment of Post-partum Haemorrhage: New Advances for Low Resource Settings International Confederation of Midwives (ICM). International Federation of Gynaecology and Obstetrics (FIGO); 2006.

Correspondence: Joyce CS Camargo (joyce@usp.br)

Background

Waterbirth (WB) is the complete underwater fetal expulsion [1,2] with much discussion [3] about it. Aqua Apgar [4] is an index that evaluates the newborn’s vitality (NB) while still submerged in water until life’s first minute, developed by Cornelia Enning.

Objective

To know the neonatal outcome of the Waterbirth Project (PWB) at a Setubal’s (Portugal) Hospital, São Bernardo. Study’s Question: What is the neonatal outcome of new-borns born in PWB?

Methods

Cross-sectional study, observational, descriptive based on ethical guidelines (CNPD-9885/2015) approved by the hospital, whose delivery-room’s infrastructure, protocol’s definition and obstetric-team’s technical and scientific training began in 2006. The PWB occurred between 2011-2014. 153 women with single pregnancy, gestational age ≥ 37 weeks with low-risk prenatal care participated in the PWB and signed an informed consent form about study’s benefits and risks, resulting in 90 waterbirth. Data were collected from the specific PWB form in April 2016. Data management was developed in Excel® and SPSS® version 16.0 programs.

Results

The 1st minute’s Aqua Apgar and the 5th minute’s Apgar were superior to 7 in all the cases, with an average of 9.4 at the 1st minute and 9.9 at the 5th minute. A cross-sectional-study in Sydney [5] observed minor Apgar and may be due to disregarding that water-born NB manifest their vitality by moving the legs and arms, opening and closing their eyes and mouth and swallowing [4]. A cohort study in the UK [6] corroborates our study that NB of aquatic birth were less likely to have a low Apgar score in the 5th minute. The use of Aqua Apgar in our study allowed a coherent outcome in the NBs who is kept submerged in water until life’s first minute, with a soft transition to extra uterine life and with no negative repercussions on heart rate and absence of complication or neonatal hospitalization.

Conclusions

This study provides evidences that may support clinical decisions regarding delivery in water. Further studies on Aqua Apgar should be conducted to support evidence-based practices.

Correspondence: Daniela Brandão (danielafsbrandao@gmail.com)

Background

In Portugal, the number of centenarians almost tripled over the last decade from 589 centenarians in 2001 to 1526 in 2011 [1], and recent projections point to the existence of 3,393 centenarians in 2013 [2]. Reaching the age of 100, though an important landmark, does not necessarily indicates successful aging as it is often accompanied by severe health and functional constraints. Understanding health trajectories of these long-lived individuals and studying the prevalence of diseases that are the most common causes of death is important for conveniently addressing their current caregiving needs.

Objective

The aim of this study is to present an overview of the sociodemographic and health-related characteristics of two distinct samples of Portuguese centenarians (predominantly rural vs. predominantly urban) and acknowledge potential dissimilarities.

Methods

A sample of 241 centenarians was considered (140 from the PT100 Oporto Centenarian Study and 101 from the PT100 Beira Interior Centenarian Study). Sociodemographic information, nature and number of diseases, functionality and physical health variables were collected.

Results

In both samples, most centenarians were female (89.3% in Oporto, and 86.1% in Beira Interior), and widowed (76.4% in Oporto, 91.1% in Beira Interior), and lived in the community (57.9% in Oporto, 49.0% in Beira Interior). Higher levels of basic activities of daily living (BADL) and instrumental activities of daily living (IADL) dependency were found in the Oporto sample, as well as a higher percentage of bedridden centenarians (61.0% in Oporto vs. 38.1% in Beira Interior). Sensorial impairments and incontinence were the most frequent conditions reported in both samples; however, lower percentages of age-related illnesses were found in the Beira Interior sample. Considering the three most lethal diseases among the elderly population (heart disease, non-skin cancer and stroke), 60.0% of centenarians in Oporto escaped these conditions, whereas in Beira Interior this percentage increases to 85.4%.

Conclusions

This study provides a general overview about the health profile of Portuguese centenarians in two types of communities: one rural and with low population density, and another in an urban context. Our findings raise important differences between centenarians from the two samples, which reinforce the heterogeneity of this population, and the importance of environmental factors in how such an advanced age was achieved. Findings highlight the need for potentially distinctive health promotion initiatives in these two settings.

Acknowledgements

This work was supported by the Portuguese Foundation for Science and Technology (FCT) [PhD Grant for the first author - SFRH/BD/101595/2014]. The PT100 Oporto Centenarian Study was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest – C/SAU/UI0688/2011 and C/SAU/UI0688/2014).

Correspondence: João Tavares (enf.joaotavares@hotmail.com)

Background

Functional decline, diminished performance in at least one activity of daily living, is often of 30 to 60% among hospitalized older adults (OA) [1]. Quality nursing care is essential to prevent functional decline. A “new” theoretically based philosophy of care has been proposed: the Function Focused Care (FFC), which is geared toward optimization of function and physical activity during all personal/care related activities that occur throughout the hospital stay [2]. The FFC has demonstrated better outcomes at discharge and post-acute periods.

Objective

To evaluate the effect of an educational program for nurses in promoting the FFC among hospitalized OA.

Methods

This is a prospective quasi-experimental study developed in four internal medical units. These units were randomly selected in two units for case (intervention) and two for control. Participants were 117 OA and 94 registered nurses (RN). Intervention consisted in the development and implementation of an educational program about FFC to RN, lasting 10 hours, and a maintenance program, during 5 months. Further details about the program can be found in Tavares et al [3]. Implementation of FFC activities by RN was assessed through the FFC Behaviour Checklist, which was completed by the researchers through non-participant observation [4]. The measures for patients were the functional decline (DF) assessed by the Katz Index: difference between baseline and discharge (t0), discharge and follow-up of 3 months (t1) and baseline and follow-up (t2). For comparison of the case and control groups, an independent t-test was calculated.

Results

The patient’s sociodemographic and clinical characteristics showed no statistical differences between groups. The provision of FFC mean was 0.46 ± 0.22, indicating that RN promoted only 46% of total possible FFC activities. Significant statistical differences were found between case and control group (t(91)= -2.85; p= 0.01), with means of 0.52 ± 0.24 and 0.39 ± 0.19, respectively. No statistical difference was found between the promotion of FFC and the functional decline at t0 (U = 30.5, p = 0.15), t1 (t(38.82) = 6.293; p< 0.15) or t2 (t(83) = 2.49, p = 0.44).

Conclusions

Promotion of functionality is very low, which could be explained by the lack of impact in FD prevention. However, in the case group, more FFC activities were developed. These results suggest a positive impact of the educational program in OA care. The FFC can be seen as a challenge and opportunity for change, innovation, and creativity, in order to improve the effectiveness, efficiency, and quality of care of hospitalized OA.

O36 Self-reported data and its relation to the standard and validated measures to predict falls

Anabela C Martins, Catarina Silva, Juliana Moreira, Nuno Tavares

Correspondence: Anabela C Martins (anabelamartins@estescoimbra.pt)

Background

According to National Institute for Health and Care Excellence quality standards, the assessment of fall risk and preventing falls should be multifactorial and include self-reported questions like fall history, fear of falling (FoF), self-perception of functional ability, environment hazards, gait pattern, balance, mobility and muscle strength [1]. Concerning the self-reported data, some studies described subjectivity and difficulty in extracting reliable information when using such methods. History and number of previous falls are often used as golden standard in fall risk assessment studies [2]; however, these questions are source of misjudgement, in part, due to difficulty for an older person remember exactly how many times he/she had fallen in a past period of time.

Objective

The study aimed to compare self-reported questions and standard and validated measures for screening risk of fall to verify the confidence of the self-reported data.

Methods

506 community-dwelling adults aged 50+ years old (mean age 69.56 ± 10.29 years old; 71.7% female) were surveyed regarding demographics, history of fall, FoF, sedentary lifestyle, use of upper-extremities to stand up from a chair, by self-reported questionnaire; analysis of gait, balance and muscle strength, by standard and validated measures for screening risk of fall - 10 meters walking speed test [3], Timed Up & Go test [4] and 30 second sit to stand test [4], respectively. Independent samples t tests were performed to compare groups.

The findings suggest that self-reported data like history of falls, sedentary lifestyle, FoF and use of upper extremities to stand up from a chair, obtained by simple questions, have emerged as reliable information on risk factors for falling and can be used to complete the fall risk screening.

Acknowledgements

Authors would like to thank all participants and centres, clinics and other entities hosting the screenings. Financial support from project FallSensing: Technological solution for fall risk screening and falls prevention (POCI-01-0247-FEDER-003464), co-funded by Portugal 2020, framed under the COMPETE 2020 (Operational Programme Competitiveness and Internationalization) and European Regional Development Fund (ERDF) from European Union (EU).

O37 Life after falling: which factors better explain participation in community dwelling adults?

Juliana Moreira, Catarina Silva, Anabela C Martins

Correspondence: Juliana Moreira (juliana.moreira@estescoimbra.pt)

Background

Participation is defined by World Health Organization (WHO), as the person’s involvement in a life situation [1]. There are few studies exploring the association between participation restriction and being older, exhibiting more depressive moods, poor mobility, and a lack of balance confidence [2,3].

Objective

The objective of this study was to identify which factors, namely, age, functional capacity and self-efficacy for exercise have the best association with participation.

Methods

A sample of 168 community-dwelling adults (age ≥50 years), mean age 70.45 ± 10.40 years old (78.6% female), with history of at least one fall in the previous year, participated in the study. Measures included demographic variables, functional capacity, assessed by six functional tests: Grip strength, Timed Up and Go (TUG), 30 seconds Sit-to-Stand, Step test, 4 Stage Balance “modified” and 10 meters Walking Speed and two questionnaires (Self-efficacy for exercise and Activities and Participation Profile related to Mobility - PAPM). Descriptive and correlational statistics were performed to analyse data.

This study suggests that participation of individuals with history of fall is associated with functional capacity, self-efficacy for exercise and age. Previous studies have showed comparable findings [4,5,6], however, admitting the strong association between participation and 10 meters Walking Speed and TUG, it is essential to include these instruments in a comprehensive evaluation of the individuals who have suffered a fall in the past year to predict participation restrictions. The performance assessed, in few minutes, by these tests, will gather information about balance and mobility impairments, that associated with a quick assess of Self-efficacy for exercise [7] will outline the quality of life of persons with history of falls.

Acknowledgements

Authors would like to thank all participants and centres, clinics and other entities hosting the screenings. Financial support from project FallSensing: Technological solution for fall risk screening and falls prevention (POCI-01-0247-FEDER-003464), co-funded by Portugal 2020, framed under the COMPETE 2020 (Operational Programme Competitiveness and Internationalization) and European Regional Development Fund (ERDF) from European Union (EU).

2. Liu J. The severity and associated factors of participation restriction among community dwelling frail older people: an application of the International Classification of Functioning, Disability and Health (WHO-ICF). BMC Geriatrics, 2017, 17:43.

O38 History of fall and social participation profile among community dwelling older adults: is there any relation with frailty phenotype?

Mónica Calha, Anabela C Martins

Correspondence: Mónica Calha (monicacalha@gmail.com)

Background

Ageing population is a worldwide phenomenon. The number of older frail people increases rapidly, which leads to a substantial impact on the economic, social and health systems. Cardiovascular Health Study data [1] estimated that, in a population with 65 years or more, 6.3% of aged adults have the frailty phenotype. According to Fried et al., frailty is a vulnerable condition characterized by the decline of biological reserves [2,3]. This happens due to deregulation of multiple physiological systems, which puts the individuals at risk by reducing the organism resistance to stressful factors, with a subsequent loss of functional homeostasis. One of the most significant aspects described in the literature is the fact that frailty is an important risk factor for falls. It is estimated that one in every three adults over 65 years fall each year. The frailty syndrome also compromises the social participation of aged adults.

Objective

To understand if adults with 65 years or over with frailty phenotype have history of falls in the period of the previous 12 months prior to the study and worst social participation, when compared to the ones who don't have this phenotype.

Methods

A sample of 122 community-dwelling adults (age ≥65 years), mean age 72.22 ± 6.44 years old (63.9% female), with history of at least one fall in the previous year participated in this cross-sectional study. Data were collected by a demographic, clinical and history of falls questionnaire, functional tests and the Activities and Participation Profile related to Mobility (PAPM).

Results

We verified that there are statistically significant differences in the history of falls between no-frailty (n = 24; mean number of falls = 1.92) and frailty/pre-frailty (n = 31; mean number of falls = 3.06) individuals (p = 0.036), as well as in the social participation score of both groups, with worse profile among the frailty/pre-frailty (0.821), when compared to no-frailty (0.276) (p = 0.000).

Conclusions

Adults with 65 years or over who present frailty or pre-frailty phenotype, when compared to no-frailty ones, have higher rate of falls in the previous 12 months and more restrictions in social participation. Physiotherapists benefit from this knowledge to understand needs of this population and to plan interventions focus on prevention of falls and strategies to promote participation as promising outcomes.

Community dwelling adults, Frailty phenotype, Risk of falls, Social participation.

O39 Sexual assistance through the eyes of sex workers: one path to improve sexual lives of people with disabilities

Ana R Pinho1, Fernando A Pocahy2, Conceição Nogueira1

1Center for Psychology, Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; 2Universidade do Estado do Rio de Janeiro, 20550900 Rio de Janeiro, Brazil

Correspondence: Ana R Pinho (mipsi20699@fpce.up.pt)

Background

Historically, people with disabilities have been seen as asexual and their sexual rights were often neglected. Nowadays, some progresses have been made but they still face multiple stereotypes and barriers that limit their social and sexual lives. Sexual assistance is a way of sexual expression in which trained individuals provide sexual services to clients with disabilities, improving their well-being in relation to sexuality. However, in Portugal the only way to access commercial sex is through sex workers who have no training to attend disabled clients.

Objective

To understand if sex workers see training as a useful aspect to be taken into account for improving psychological and sexual health of clients with disabilities and themselves.

From the analysis of the interviews four themes have emerged. Sex workers theme focus on the life experiences and motivations to attend clients with disabilities. Clients theme characterizes who are the people with disabilities seeking commercial sex. Search for sex work theme deepens knowledge about how they get in touch with sex workers. Finally, the attendance theme explains the dynamics of the relationship established and the many obstacles they overcome in order to express their sexuality through commercial sex.

Conclusions

The main conclusions provide evidence of the use of commercial sex by people with disabilities who seek in this service sexual and emotional satisfaction. Certain relationship specificities tend to be experienced with feelings of embarrassment on the part of professionals. Based on the experiences and obstacles sex workers observed when working with people with disabilities, measures were pointed out to improve the psychological and sexual health of those involved in the situation, which highlights the need for training to serve this group of clients, as well as the need for legalization of sex work.

O40 Results of an intervention program for men who batter women: perceptions of accompanied men

Anne CLG Silva, Elza B Coelho

Correspondence: Anne CLG Silva (anne_clg@hotmail.com)

Background

In intimate partner violence, man is the main perpetrator of violence, and it is essential to include him in interventions to decrease violence, because he can take responsibility for violence, seeking new forms of expression. However, intervention with men is criticized, such as: using resources that could be targeted to victims; the imposition of re-education measures rather than punitive measures; consider that men do not change their behaviour [1]. Nevertheless, it is within the framework of evaluation that we find one of the major shortcomings of batterer intervention programs, since the effects of participation of men in that, have been receiving little analysis [2].

Objective

This research aims to analyse the results of a batterer intervention program from the perspective of man accompanied by the program.

Methods

It is a case study conducted in a batterer intervention program with 86 men. It was used the Centres for Disease Control and Prevention Follow Up Questionnaire, adapted to be used in Brazil. Data were analysed according to content analysis techniques. This project was approved by the Human Research Ethics Committee of the Infantile Hospital Joana de Gusmão. Subjects were asked to agree through an informed consent.

Results

When asked about changes occurred after 3 months of follow-up in the program some men reported having not noticed any changes, which indicates that the program is not effective to all participants and the importance of longer follow-ups. However, most men cited changes in the way they act and perceive the division of tasks between men and women, thus participation in the program can be the starting point for rethinking and building new ways of expressing masculinity. And the changes cited go beyond the scope of the marital relationship, encompassing the relationship with the children, the abandonment of addictions and the desire to seek school education.

Conclusions

According to the data, attention to perpetrators of violence has a positive influence not only in the behaviour towards the partner, but also on the relationship with children and the abandonment of addictions. Although longer follow-ups - including the couple - are needed, the batterer intervention program may be a tool to decrease violence against women.

Correspondence: Isabel Gil (igil@esenfc.pt)

Background

Reminiscence is a therapeutic intervention based on the account of personal experiences that allows access to significant life events. Evidence suggests that this intervention is particularly beneficial for the elderly with neurocognitive disorders [1], especially with regard to psychosocial variables. In Portugal, this intervention is underused, and there is a need to study its applicability and efficacy.

Objective

To evaluate the effect of a reminiscence-based program (RBP) [2] on cognitive frailty, quality of life and depressive symptomatology in elderly people attending day-care centres. Evaluate professional's satisfaction with the program and identify obstacles in its implementation.

Methods

A quasi-experimental study with one group was carried out in four day-care centres in the central region of Portugal. The framing sample included 69 older adults aged ≥ 65 years. Of those, 28 (average age of 79.33 ± 7.35 years and average education of 3.29 ± 1.86 years) participated in the 7-week RBP, twice a week. Outcomes of interest were cognitive frailty indicators measured through the Montreal Cognitive Assessment (MoCA); quality of life measured using the short version of World Health Organization Quality of Life Scale-module for older adults (WHOQOL-OLD-8); and depressive symptomatology measured by the 10-item Geriatric Depression Scale (GDS-10). In addition, the eight professionals conducting the study were asked to identify obstacles to the successful implementation of the program, and to evaluate its structure, themes, contents, and the involvement of the elderly in each session.

Results

RBP was shown to have positive effects on the MoCA and WHOQOL-OLD-8 score (p < 0.05). Improvement in the GDS-10 score was observed; however, it was statistically non-significant. The structure of the program sessions was considered as mostly clear and perceptible (94%), and themes and contents as mostly pleasant and appropriate (94%). Positive feedback was obtained regarding the program capacity to involve the elderly in the activities proposed (87.5%). However, according to the professionals’ opinion, there is a need for ampler capacitation of the teams implementing RBP, better articulation with the institutions regarding the used space and activities schedule, and better articulation with the elderly to guarantee their commitment to the program.

Conclusions

Reminiscence was shown to be effective in improving cognition and quality of life, as well as potentially effective in decreasing depressive symptomatology. Therefore, it presents a therapeutic potential, contributing to the improvement of the care provided. It is also worth mentioning the good acceptance of the program which, however, implies the qualification of the professional teams for its implementation.

Acknowledgements

This study was developed within the context of the project “664367/FOCUS” (funded under the European Union’s Health Programme (2014-2020)) and project ECOG (funded by the Nursing School of Coimbra).

Correspondence: Isabel Gil (igil@esenfc.pt)

Background

Research has evidenced the positive impact of non-pharmacological therapies aimed at elderly people with cognitive decline in the institutional setting. Reminiscence Therapy (RT) emerges in this category as an enabling strategy, which favours moments of happiness, dignity and life purpose [1]. Nonetheless, studies centred in RT are limited in Portugal, with a clear absence of structured interventional programs, emerging the need to develop and validate well-defined and replicable RT programs [2].

Objective

We intend to construct and validate a RT program directed to elderly people with cognitive decline, to be implemented in institutional settings by healthcare professionals.

Methods

Guidelines for complex interventions development from the Medical Research Council were followed [3]. The program was conceptualized in four distinct phases: Phase I (Preliminary), the initial conceptualization of the program design and supportive materials; Phase II (Modelling), consisting in the conduction of interviews and focus groups with healthcare specialists; Phase III (Field Test), aiming at the evaluation of each program session; and Phase IV (Consensus Conference), to synthesize the contributions and analyse challenges that emerged in preceding phases.

Results

Based on the contributions of experts, healthcare professionals and the institutionalized elderly, a RT program divided into two strands was formed. The main strand includes 14 sessions, performed twice a week. The maintenance strand included seven weekly sessions. Each thematic session is related to the participants' life course, with a maximum duration of 60 minutes. The 4-phase conceptualization process resulted in the creation of a digital platform with audio-visual contents to aid professionals during each session; inclusion of an introductory section that contextualizes the therapeutic potential of RT; introduction of complementary activities that can be developed additionally in the institutional settings; reinforcement of multisensory stimulation throughout the program; introduction of a final moment of relaxation through abdominal breathing. The terminology used and visual presentation of the program were reformulated in order to improve user experience. The created program was considered by the elderly and healthcare professionals involved during the course of this process as pleasant and interesting, praising its structure, thematic contents and proposed activities.

Conclusions

The involvement of experts and potential users enabled the program to mirror the needs of the elderly with cognitive decline in an institutional setting. The RT program, structured and validated in the course of this study, demonstrated characteristics adjusted to the target population and setting. However, the effectiveness of the program should be tested in a future pilot study.

Acknowledgements

This study was developed within the context of the project ECOG, funded by the Nursing School of Coimbra.

Correspondence: Francisco Sampaio (fmcsampaio@gmail.com)

Background

Several efficacious treatments for anxiety are available, among which different forms of psychotherapy and pharmacotherapy [1]. However, literature favour more findings stemming from studies about the efficacy of psychotherapies/therapies provided by nurses [2,3] than those arising from studies about the efficacy of nursing psychotherapeutic interventions (interventions classified, for instance, on Nursing Interventions Classification) [4]. Moreover, no studies were found in literature about the efficacy of psychotherapeutic interventions on anxiety as a symptom.

Objectives

Evaluating the short-term efficacy of a psychotherapeutic intervention in nursing on Portuguese adult psychiatric outpatients with the nursing diagnosis “anxiety”.

Methods

A single-blind randomised controlled trial was conducted at a Psychiatry Ward Outpatient Service of a Hospital in the north of Portugal. Participants were psychiatric outpatients, aged 18-64, with nursing diagnosis “anxiety”, who were randomly allocated to an intervention group (n = 29) or a treatment-as-usual control group (n = 31). The interventions consisted in psychotherapeutic interventions for the nursing diagnosis “anxiety”, integrated in the Nursing Interventions Classification. One mental health nurse provided the individual-based intervention over a 5-week period (one 45-60 minutes weekly session). A treatment-as-usual control group received only pharmacotherapy (if applicable). The primary outcomes, anxiety level and anxiety self-control, were assessed with the outcomes “Anxiety level” and “Anxiety self-control”, integrated in the Nursing Outcomes Classification (Portuguese version) [5] respectively. Time frames for assessment were at baseline and post-test (6 weeks after).

Results

Patients from both groups presented improvements in anxiety levels, between the pre-test and the post-test assessment; however, analysis of means showed that patients of the intervention group presented significantly better results than those of the control group. Furthermore, only patients in the intervention group presented significant improvements in anxiety self- control. The psychotherapeutic intervention presented a very large effect size on the anxiety level and a huge effect size on the anxiety self-control. 22.8% and 40% of the outcomes related to the anxiety level and anxiety self-control, respectively, are predicted in the event of integrating the intervention group.

Conclusions

This study demonstrated the psychotherapeutic intervention model in nursing was efficacious in the decrease of anxiety level and improvement of anxiety self-control in a group of Portuguese adult psychiatric outpatients with pathological anxiety, immediately after the intervention. The results of the multiple linear regression and the very large effect size identified suggest that a significant part of the improvements could be directly attributed to the intervention.

Correspondence: Clara Campos (ccalmeidacampos@gmail.com)

Background

In the last few years, some researchers have focused on the valorisation of interventions that stimulate the use of art therapy in individuals with mental illness. This assessment is based on the assumption that biological programs (including psycho pharmaceuticals) should be increasingly inclusive, and therefore should include psychosocial approaches based on the recovery model. However, there is as yet no effective consensus on techniques and interventions that reveal greater effectiveness as well as systematization.

Objectives

a) Evaluate the effectiveness of a program of 3 sessions of “art therapy” in individuals with mental illness, in the change of emotional indicators, namely depression, anxiety, stress, and psychological well-being; b) analyse the meanings attributed by the person to his creative self-expression.

Methods

We chose a pre-experimental study, of mixed approach (quantitative and qualitative), with pre- and post-test design and without control group. Twelve male subjects mostly diagnosed with Schizophrenia and Mood Disorders, who were admitted to an acute psychiatry unit, participated in the study. The instruments used to collect information were: Depression, Anxiety and Stress Scale [DASS-21]; Subjective Well-Being Scale (EBEP-18 items) and a semi-structured interview.

Results

The main results suggest, after the evaluation between the pre- and post-test that there was an improvement in the dimensions anxiety, stress, self-acceptance, life goals and overall psychological well-being. The categories that resulted from the thematic analysis of the interviews (hope for the future, learning to manage difficulties and dealing with difficult emotions) revealed the usefulness of the program in the participant’s recovery process.

Conclusions

The inclusion of this type of psychosocial intervention in specialized clinical practice in Mental Health Nursing allows minimizing the impact of the disease in an organizational culture that should increasingly be oriented towards recovery.

Correspondence: Bárbara Pinto (barbarapinto_41@hotmail.com)

Background

The birth of a child corresponds to a new stage in the family life cycle and implies a process of restructuring, adaptation to physical, psychological, family and social readjustments [1]. This transition predicts a change of roles of all the members of the family and the construction of a new personal, conjugal and familiar identity [2]. From institutions and health professionals, interventions are expected to successfully overcome these challenges. At this stage, the home visit imposes itself as an important intervention in Nursing care. Its accomplishment, by the family nurse, promotes individual and family empowerment and autonomy in healthy parenting.

Objectives

Understanding the couple's perception about nursing practices in the context of home visit postpartum, as a contribution to the transition to parenting.

Methods

The research was based on the phenomenological domain, in a qualitative approach and includes eleven couples experiencing parenthood for the first time, between October 2016 and January 2017, enrolled in the Family Health Unit of Barrinha. Data collection included semi-structured interviews were conducted in order to guarantee the narratives of the experiences and their deeper understanding. The information was analysed according to the technique of content analysis, using WEBQDA software.

Results

This study revealed that the birth of the first child is an event of individual and family development and growth, which implies adaptation to a set of changes and redefinition of roles, built on a day-to-day basis, and in close cooperation between the family and the nursing team. The approach in the home nursing visit was directed to the well-being of the new born and its mother, appearing to the family as a resource, not having the concern to explore the interaction and the reciprocity within the family. We highlight three dimensions: Postpartum home visit, that describes the experiences of the participants about the care operationalized in this visit; Family Nursing, which traces the way they understand the work of the family nurse in this transition and, lastly, the Postpartum parenting, which reports the mother perception about this stage of the life cycle.

Conclusions

The home visit and work philosophy by the family nurse contributed to the positive adaptation to parenthood and to approach the family and added value for improvement of the quality of health care, yet it was not assumed as a reality in the context of caring.

Correspondence: María Y González-Alonso (mygonzalez@ubu.es)

Background

The acquisition of skills throughout the career facilitates the professional practice and satisfaction of the occupational therapist. In order to give direct attention to a situation of disability or risk, the professional must apply the best evidence-based strategy; and to establish a productive relationship with the client, the professional needs to learn to use interpersonal skills.

Objective

The objective of the study was to analyse how the perception of occupational therapy students changes their personal traits and challenges throughout their careers.

Methods

This is a descriptive, cross-sectional study of an intentional sample consisting of 183 students of occupational therapy. The study is part of the 2016-2017 academic course. An ad hoc questionnaire was prepared based on the collection of personal data and the perception of 29 skills that [1] proposed: The students should value the traits and challenges.

Results

Of the 183 students, 122 were from the first and 61 from the final year, 47.5% from Belgium and 52.5% from Spain. The profile of the sample was 85.8% women; 60.1% live with their family and 85.8% had not done work placements outside their country. Regarding the skills that defined them, the respondents indicated friendly, respectful and loyal, with an average of 22.4 skills. Regarding abilities that they felt they must achieve, they identified patient, firm and assertive with an average of 9.9. The first-year students self-evaluated more positively than those in their final year in respect to the different variables. Significant differences related to the course were only observed in two traits: empathetic and collaborative.

Conclusions

Occupational therapy students, those in both their first and final years, consider that they have a large number of relational skills which enable them to give an appropriate response to the events that occur in therapy. Empathy is the only trait which indicates differences depending on the independent variables studied. for improvement of the quality of health care, yet it was not assumed as a reality in the context of caring.

References

1.Taylor, R.R. The International relationship: Occupational Therapy and the use of self; Philadelphia: F.A. Davis; 2008.

O47 Use of performance-enhancing substances in Portuguese gym/fitness users: an exploratory study

Ana S Tavares, Elisabete Carolino

Correspondence: Ana S Tavares (ana.tavares@estesl.ipl.pt)

Background

The use of performance-enhancing substances (PES) by competitive or recreational sports practitioners is a pertinent and current topic, particularly in the field of public health. People who use gyms come from diverse socio-demographic conditions, where the consumption of this type of substances is not only used for the purpose of improving physical performance, but also to obtain a more muscular physique, especially for men, and leaner, especially for women whose goal is faster weight loss [1]. In Portugal there are practically no studies on the use of PES outside competitive sport, highlighting a study developed in 2012 by the European Health & Fitness Association [2].

Objective

Investigate the prevalence and profile of PES users amongst a sample of Portuguese gym/fitness users.

Among the 453 gym/fitness users (61.3% female; 38.7% male) who participated in the survey, 50 (11.1%) reported PES use (5.4% female; 19.5% male). The mean age of PES users was 34.96 years (Std. Dev. = 10.00). They were married, unemployed and with a low level of education (until 9 years = 41.7%). PES users showed more years of training (4 years) than no PES users. The main sports modalities of the respondents were cardio fitness (57.0%), bodybuilding (56.5%), stretching (27.8%) and localized (27.2%). PES use was suggested mostly by friends (51.9%), peers (30.8%) and by internet (30.8%). The most commonly consumed PES were diuretics (46.0%) and anabolic steroids (44.0%). Thirty percent of PES users reported side effects and the most commonly reported was acne (53.3%), agitation and tremors (40.0%). The main reason for using PES is the improvement of the physical condition (54.0%). Five-point three percent of non-PES users expressed an interest in using PES in the future.

Conclusions

This exploratory survey revealed the use of PES amongst Portuguese gym/fitness users and its increasing importance to investigate the psychosocial factors that may influence PES use in this specific population. Exploring these factors may improve the effectiveness of practical interventions and motivational strategies to reduce PES use among gym/fitness users.

2. European Health and Fitness Association. Executive summary of the final report for the Copenhagen Fitness Anti-Doping Conference. Bruxelles; 2012.

Keywords

Performance enhancing substances, Orevalence, Gym/fitness users.

O48 Identification of frailty condition of elderly people in the community

Inês Machado1, Pedro Sá-Couto2, João Tavares3,4

1Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; 2Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro, 3810-193 Aveiro, Portugal; 3Nursing School of Coimbra, 3046-851 Coimbra, Portugal; 4Coimbra Education School, Polytechnic Institute of Coimbra, 3030-329 Coimbra, Portugal

Correspondence: Inês Machado (inessantiago@live.ua.pt)

Background

Frailty is a geriatric syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death [1]. Current research is still under discussion regarding the nature, definition, characteristics and prevalence of frailty. Identify frail older adults (OA) has recently been recognized as an important priority, especially in community-dwelling OA.

Objective

Determine the prevalence of frail OA in a primary care (PC) settings and to assess the concurrent validation of the Portuguese version of Prisma7 (P7) with two other published and validated instruments: Frailty Phenotype (FF) and the Groningen Frailty Indicator (IFG).

Methods

This study was conducted in one PC unit in the north region of Portugal with a convenience sample of 136 OA (≥ 65 years). The questionnaire included: 1) sociodemographic, family and health variables; and 2) the frailty instruments P7, FF and IFG. OA were considered frail: ≥ 3 positive questions out of 7 for P7; ≥3 factors out of 5 for FF; and ≥ 4 dimensions out of 8 for IFG. Further details about these scales can be found in Machado. For the concurrent validity, methods based on correlation (Spearman Rank test) and agreement (Cohen's Kappa, sensitivity and specificity values) were used. For comparison of the two groups (frailty or non-frailty), an independent t-test was calculated. Finally, binary logistic regression model was considered to identify predictors of frailty.

Results

According to the characterization of P7, IFG and FF, the prevalence of frail OA was 7.4%, 19.9% and 26.5%, respectively. The agreement percentage between the instruments was moderate ranging from 68% to 77%, observing that the P7 is partially concordant with the other instruments. The P7 showed high specificity values, but low sensitivity values. Frail OA were characterized (p < 0.05) as being older, having worse health perception, lower physical capacity, slower walking velocity, higher IFG scores, and decreased hand grip strength. As predictors of frailty, in the multivariate model, older age (OR = 1.111) and better physical capacity (OR = 0.675) were significant (p < 0.01).

Conclusions

A sample of more robust people and a “synthetic” application of P7 (without explaining the questions) may have influenced the prevalence results presented. More studies are needed in order to further evaluate the psychometric properties of the various tools tested. The P7 should be used with caution in identifying frailty in PC, therefore we suggest the incorporation of another measure of frailty assessment.

Acknowledgements

This work was supported in part by the Portuguese Foundation for Science and Technology (FCT-Fundação para a Ciência e a Tecnologia), through CIDMA - Center for Research and Development in Mathematics and Applications, within project UID/MAT/04106/2013.

Correspondence: Ana Sucena (sucena.ana@gmail.com)

Background

The learning difficulties of the letter-sound relations are seen as a risk factor for future difficulties in learning to read [1]. Ideally, the identification of children at risk of failure to learn reading and writing should occur in the last year of pre-school or early in the first year, so that intentional programs can be implemented to promote basic reading skills [2,3,4]. The most promising reading learning support programs combine explicit phonological awareness training with highly structured reading instruction [5,6].

Objective

This study evaluated the impact of two early intervention programs on reading learning difficulties. A program exclusively in virtual environment and a hybrid program, comprising sessions in virtual environment and in real environment.

Methods

Participants were 57 children, attending the first year of schooling, native speakers of European Portuguese, identified as at risk of having learning reading difficulties. The children were divided into three groups: (a) virtual environment intervention - training with Graphogame software, (b) hybrid intervention - training using Graphogame software and real-time sessions of pre-reading and reading skills oriented by a technician from the CiiL team (Center for Research and Intervention in Reading) and (c) absence of intervention beyond that provided for in the regular system of education. The intervention programs were developed in a school context, with the virtual component (Graphogame) developed with daily periodicity, with duration between 10 to 15 minutes. The intervention in real environment was carried out once a week, with activities of 30 to 40 minutes, using materials of a playful character, created specifically for the present study. In both types of sessions, the groups consisted of two to five children. The participants were evaluated at the level of letter-sound relations, phonemic awareness, word reading and pseudo word reading.

Results

Both intervention environments produced significantly more positive effects than those obtained by the control group. Still, the software Portuguese Basis Graphogame is an effective tool, however, with a more positive effect when used in parallel with a face-to-face reading promotion session.

Conclusions

The early intervention in reading difficulties should promote the explicit training of phonemic awareness and letter-sound relations in order for the decoding process to be developed. Although the virtual environment – in this case the software Portuguese Basis Graphogame – is a highly effective tool, ideally, it should be combined with a real-environment intervention to ensure that the child effectively dominates letter-sound relationships and that trains intensively the decoding process.

Correspondence: André RTS Araujo (andrearaujo@ipg.pt)

Background

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used medications in the world because of their analgesic, antipyretic and anti-inflammatory properties [1–3]. However, their use is associated with the occurrence of serious adverse drug events, particularly gastrointestinal, cardiovascular and renal complications [3].

Objective

To assess the NSAIDs consumption pattern by the adult residents in the north and central regions of Portugal, as well as, to evaluate their individual's behaviour concerning the resulting residues after the use of the packages of medicines.

Methods

A questionnaire survey was administered to a sample of 400 pharmacy costumers in the districts of Aveiro, Leiria, Porto and Viseu between December 2015 and February 2016, with questions regarding the knowledge of NSAIDs consumption and their attitudes towards the medicine residues.

Results

In our study, the prevalence rate of NSAIDs use in the last 6 months was 74.3 % (95 % CI 70.0–78.6), showing a high level of consumption of this pharmacotherapeutic group. The most commonly used NSAID was ibuprofen (76.4 %), followed by diclofenac (36.0 %) and nimesulide (8.4 %). The most reported therapeutic indications were headaches (36.4 %), followed by back pain (33.3%), fever (24.6%) and flu (20.5%). Surprisingly, adverse drug events were reported by only 6.7 % of respondents. Even so, the most common adverse drug event was diarrhoea (4.0%). These results could be explained considering that NSAIDs use is episodic and limited to shorter periods and probably the respondents did not correlate the adverse effects of these medicines. Relatively to the destination of the packages of medicines that respondents no longer used, it was verified that 58% of the respondents claimed to deliver them in a pharmacy, 17.3% throw away in the common waste, 24.0% keep them at home, 0.5% put in sanitary sewers and 0.2% donate to charities.

Conclusions

According to these findings, it was evident the trivialization of NSAIDs consumption, being imperative to monitor their use and educate the users for its rational use. On another hand, it is important to maintain the incentive and to educate the population to adopt adequate attitudes regarding medicine residues recycling.

Correspondence: André RTS Araujo (andrearaujo@ipg.pt)

Background

Allergic rhinitis (AR) is a hypersensitivity reaction caused when inhaled particles contact the nasal mucosa and induce an immunoglobulin E -mediated inflammatory response resulting in sneezing, nasal itching, rhinorrhoea, nasal obstruction, or a combination of those symptoms [1]. The prevalence of AR is sometimes cited as 10% to 30% in adults [1]. It is increasingly recognized that the symptoms of AR often adversely impact the quality of life of the affected individuals and impose a significant health and socio-economic burden on the individual and society [2].

Objective

The aims of the present research were to estimate the prevalence of AR, determine the predominance of the symptoms, determine the impact on quality of life (QoL), as well as characterize the control strategies and treatment of AR in pharmacy customers of Guarda city.

Methods

An observational, cross-sectional and analytical study was conducted, and a questionnaire survey was developed and used as the data collection instrument. This included the Control of Allergic Rhinitis and Asthma (CARAT) test and the scale Quality of Life of the World Health Organization (WHOQOL-Bref). Data collection took place in community pharmacies in the city of Guarda between May and December of 2014.

Results

In the sample of 804 respondents, there was a predominance of females (66.3%) and the average age was 48.3 ± 16.5 years. The prevalence rate of AR was 13.1% (95 % CI 10.8–15.4). About 40% of the respondents with AR had no medical diagnosis. It was verified that there weren’t differences by gender in terms of quality of life (p = 0.929) or in the control of the AR symptoms (p = 0.168). On another hand, a high level of education (higher education) seemed to be a factor that contributed to a better quality of life (p = 0.001) and to a better control of symptoms (p = 0.019). It was also observed that a better control of the symptoms of AR was associated with a better quality of life (Pearson’s r = 0.292, p = 0.003).

Conclusions

The prevalence rate was estimated between 10.8% and 15.4%, which resulted from the medical diagnosis and the symptomatic diagnosis made through the data collection instrument. The results indicated that although the respondents do not have properly controlled the AR and suffer from associated comorbidities, they have a reasonable quality of life indexes.

One of the most controversial abnormal patterns during walking in patients with stroke occurs during weight transfer (WT) of the paretic lower limb, however no perception of the knee patterns developed during stroke recovery exists.

Objective

To explore the importance of the knee kinematic pattern in the weight transfer (WT) walking period for functional recovery in the first 6 months post-stroke.

Methods

Inpatients with a first ischemic stroke (< 3 months), able to walk, were evaluated (T0) and revaluated 6 months post-stroke (T1). Patients were video-recorded in the sagittal plane while walking at their self-speed and the video was used to classify the knee pattern during WT. Walking speed, self-perceived balance, knee muscle strength and sensory-motor function of the hemiparetic lower limb were also assessed. Participants were stratified according to the knee pattern recovery. Comparisons between and within groups were conducted.

The knee pattern correction in WT might have benefits for stroke recovery. A further understanding of the causes for deviations in the knee pattern in WT will help establishing stroke treatment priorities.

Trial Registration

NCT02746835

Keywords

Weight transfer, Gait, Stroke, Knee patterns.

O53 Reference values of cardiorespiratory fitness field tests for the healthy elderly Portuguese

Patrícia Rebelo1,2, Ana Oliveira1,2,3, Alda Marques1,2

1Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; 2Institute for Research in Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal; 3Faculty of Sports, University of Porto, 4200-450 Porto, Portugal

Correspondence: Patrícia Rebelo (patriciarebelo@ua.pt)

Background

Cardiorespiratory fitness (CRF) is recognized as an independent predictor of all age morbidity and mortality and is closely related with people’s functional capacity [1]. Recently, CRF has been described as a clinical vital sign, which highlights its role in health promotion and disease prevention [2]. The 6-min-walk test (6MWT), incremental shuttle walk test (ISWT), unsupported upper limb exercise test (UULEX) and the 1-min sit-to-stand test (1’STS) are worldwide tests to assess CRF. Reference values of these tests are however, lacking for the Portuguese elderly population. This hinders the interpretability and limits the confidence of clinical decision-making in the field of CRF.

Objective

To contribute for establishing reference values for the 6MWT, ISWT, UULEX and 1’STS in the Portuguese healthy elderly population.

Methods

A cross-sectional study was conducted with healthy elderly volunteers [3] recruited from the Centre region of Portugal. Each participant conducted two repetitions of the 6MWT, ISWT, UULEX and 1-min STS. The best repetition was considered for analysis. Descriptive statistics were used to determine reference values by age decade (61-70; 71-80; 81- 90) and gender. Two-way ANOVA was used to investigate significant effects for age/gender and their interaction. Values were presented as mean ± standard deviation or median [95%, Confidence Intervals].

The population studied presented worse results in the 6MWT, similar results in the ISWT and better results in the 1’STS test comparing with international studies [4-6]. No studies were found for the UULEX test. These differences highlight the importance of using population specific reference values in CRF assessment. Further studies with larger and representative sample sizes are needed to confirm results.

Correspondence: Clóris RB Grden (reginablanski@hotmail.com)

Background

The aging process, understood as dynamic and progressive, contributes to the reduction of physical reserves and a higher prevalence of pathological processes, predisposing the elderly to frailty [1]. Canadian researchers define frailty as a multifactor syndrome involving biological, physical, cognitive, and social factors [2], which contribute significantly to disability and hospitalization [3]. Considered a modern geriatric syndrome, it is related to physiological changes, diseases, polypharmacy, malnutrition, social isolation and unfavourable economic situation [4, 5].

Objective

The objective of this study was to identify the prevalence and factors associated with frailty in the elderly attended in outpatient care. A cross-sectional study was carried out with 374 elderly individuals in outpatient care between October 2015 and March 2016. Data collection was applied to the Edmonton Fragility Scale [2]. Data were analysed by Stata software version 12 and described by measures of frequency, mean and standard deviation (SD). Prevalence ratios (PR) were calculated to investigate associations between independent variables and frailty. The adjusted prevalence ratios were obtained by multiple Poisson regression analysis. It was started with a saturated model and the variables that were not statistically relevant were removed, since their exclusion did not modify the results of the independent variables that remained in the model. The statistical significance was p < 0.05. The study complied with national and international standards of research ethics involving human subjects and was approved by the Research Ethics Committee in Human Beings of the institution under registration CAAE: 34905214.0.0000.0105.

Results

The results showed a predominance of female (67.4%), married (54.4%), with low educational level (55.1%), who lived with relatives (46.3%). The mean age of participants was 67.9 years. Regarding the clinical variables, 97% of the elderly reported having some type of disease, 92.3% used medication, 56.9% had no urine loss, 4.5% used walking sticks, 65.8% denied falls and 69.8% hospitalization. Regarding the fragility syndrome, the mean score was 5.9 points, with 40.1% elderly classified as fragile and 59.9% non-fragile. After multiple regression analysis, the variables that remained associated with the fragility were gender (p = 0.002), low education (p = 0.01), falls (p = 0.005), urinary incontinence (p = 0.000) (p = 0.001), medications (p = 0.02) and hospitalization (p = 0.001).

Conclusions

The study identified important factors associated with frailty in the elderly attending the outpatient clinic. Such results may support the development of gerontological care plans aimed at preventing functional decline and negative outcomes of the syndrome.

Correspondence: Pedro CM Morais (pedromorais182@hotmail.com)

Background

Acute Myocardial Infarction (AMI) is a public health problem in the world and in Brazil, due to the high morbimortality rates observed. Despite major advances in treatment, AMI accounts for 30% of deaths in Brazil.

Objective

To analyse the mortality trend due to acute myocardial infarction in the State of Santa Catarina, from 1996 to 2014.

Methods

Ecological study of time series, based on the Database of the Mortality Information System, made available by the Department of Informatics of SUS (DATASUS). Selected deaths by AMI, ICD-10, code I21, of the resident population in the state, according to gender and age group. Performed simple linear regression. The Research Ethics Committee of the Southern University of Santa Catarina approved this study.

Results

There were 40,204 deaths from AMI between 1996 and 2014 in Santa Catarina, with small oscillations in mortality rates in the period, 40.33/100,000 inhabitants in 1996 and 36.58/100,000 in 2014 (β = -0.062, p = 0.546). There were higher rates in males, but stationary, with 49.41/100,000 inhabitants in 1996 and 45.62/100,00 in 2014 (β = -0.008; p = 0.949). The female sex presented a steady trend, with a rate of 31.19/100,000 inhabitants in 1996 and 27.49 / 100,000 in 2014 (β = -0,113; p = 0.224). The male and female age groups showed a decreasing and significant trend after 30 years. Male age group 60 and older presented high mortality rates, however, declining. It stands out that the male age group from 70 to 79 years of age presented a decrease in rates of -13,936 per year, with a variation from 626.51/100,000 inhabitants in 1996 to 379.21/100,000 inhabitants in 2014 (p > 0.001). In the male age group of 80 years or more the rate was 935.88/100,000 inhabitants in 1996 and 669.99/100,000 in 2014 (β = -12,267; p = 0.004). Female age group 70 and older presented high mortality rates. In the female age group of 70 to 79 years, there was a decrease from 399.60/100,000 inhabitants in 1996 to 193.78/100,000 in 2014 (β = -12,115; p < 0.001). The female age group aged 80 years and over, from 811.78/100,000 inhabitants in 1996, decreased to 497.81/100,000 in 2014 (β = -16,081, p < 0.001).

Conclusions

The trend of AMI mortality in Santa Catarina is stationary for both genres but decreasing significantly in the age groups over 30 years, with the greatest reductions over 70 years.

Keywords

Acute Myocardial Infarction, Mortality rate, Ecological study.

O56 Family nurse intervention in the mental adjustment of patients with arterial hypertension

Ana Alves1, João Simões1, Alexandre Rodrigues1, Pedro Couto2

Correspondence: Ana Alves (anamargaridamartins@ua.pt)

Background

The increase on life expectancy, and the raise of chronic condition, represents new challenges to the family nurse practitioner. Cardiovascular diseases are the main cause of death among the population, however the numbers have been declining in past years [1]. There is an important economic impact that is a result of the incapacity cause by such diseases, as well as the treatment-related costs. Arterial hypertension has been gaining some relevance, due to its prevalence, and because its epidemiological base studies reveal a lack of control sample. Considering this problematic, a study was conducted, that analyses the mental adjustment of patients with arterial hypertension and the impact of the family nurse practitioner during appointments for hypertension monitoring.

Objective

The objective was to evaluate the impact of the family nurse practitioner on the mental adjustment of patients that suffer from arterial hypertension, registered at the “HTA” program of the Personalised Healthcare Unit of Healthcare Centre of Sever do Vouga.

Methods

A quantitative study was conducted, meeting one of the cycles of the research-action method, since an initial analysis was conducted, followed by the implementation of the intervention, and then carried by a new evaluation. Thus, using the Mental Adjustment to Disease Scale, as an evaluation instrument, regarding mental adjustment, along with a sociodemographic and clinical characterization questionnaire, addressed to the participants. The ethical principles were followed during the entire course of the investigation.

Results

The participants in this study had and average age of 70.8 years, and being mostly females, diagnosed with for 8.4 years. To evaluate the internal consistency of MADS, it was calculated the Cronbach Alpha in moments 1 and 2, obtaining acceptable results, except for the subscale regarding fighting spirit. At moment 1 of the data collection, in the subscale regarding fighting spirit, all participants were classified as “fitted”, however for the remaining subscales, the participants were classified as “fitted” and “Not fitted”. The results obtained at moment 2, have revealed the impact from the conducted intervention, since the participants initially classified as “not fitted”, shifted to “fitted” at the 2nd moment.

Conclusions

Performing a balance of the internship, it can be claimed that the expected competences and objectives were achieved. Ultimately, we can withdraw the conclusion that the intervention developed for the mental adjustment obtained the expected results, since the participants classified as “not fitted” on the 1st moment, were classified as “fitted” during the 2nd assessment moments.

Correspondence: Júlia Alves (juliasousaalves@gmail.com)

Background

Family conference (FC) is an important work that represents an opportunity to evaluate family dynamics, provide anticipatory care and support feelings related to the loss of a loved one [1]. FC facilitates the communication between healthcare providers, patient and family and allows the discussion of different options and summarize consensus with the ultimate goal of problem solving, decision making and instituting a plan [2].

Objective

Describe the experience of FCs made by a PCST from 1 of January 2015 to 31 of December 2016.

Methods

Raw data from FCs registers was retrieved and a descriptive analysis was performed.

Results

We consulted 809 patients and 431 FCs were held (81% scheduled). In 56 FC the patient was present; when the patient was absent, most cases were due to clinical condition and in a minority the patient chose not to be present. Family members attending FCs were offspring in 67%, spouses in 23%, other relatives in 38% and the parents in 4% of cases. All meetings occurred in the presence of one physician and one nurse from the PCST. FCs were held because of patient discharge (88%), worsening of clinical condition (24%), family needs (59%), discussion of therapeutic goals (38%) and conspiracy of silence (1%). As a consultant team, the PCST is concerned with post-discharge and evaluates the needs of patients at home with the help of an ambulatory healthcare team or primary care team. Therefore, FCs have the objective of preparing families for patient discharge. During FC the main subjects of discussion were post-discharge healthcare referral (94%), objectives of healthcare (84%), clinical information about diagnosis and prognosis (42%), symptom control (47%), management of expectations concerning the illness (73%), nutrition (12%) and family needs (psychological support in 17% and nursing instructions 10%).

Conclusions

There is an increasing number of FC and more are being requested by the referral healthcare team. To facilitate the registry of FC a document was elaborated and soon it will be made a software. This registry will allow an easier analysis and strategy planning to improve interventions and healthcare quality provided.

Correspondence: Claudia Oliveira (claudiajs.oliveira@gmail.com)

Background

Diabetes mellitus is a prevalent disease among the elderly and is listed as one of the leading causes of admissions and readmission [1]. Older people with diabetes represent a challenge, in terms of effective coordination and management in multiple areas. In this sense, older population needs to adhere to a medication regimen, sometimes complex. Polypharmacy is a reality and leads to unnecessary disease progression and complications, reduces functional abilities, increases hospitalizations, reduces the quality of life, increases health costs and even deaths [2]. Management of such phenomenon is extremely hard and requires awareness.

Objective

To identify the clinical profile of the older people with Diabetes mellitus in two Family Health Units in Faro (FHUs Farol and Al-Gharb).

Methods

Observational and descriptive study was performed, with people aged 65 years or above, living in the community and registered at the Health Centre of Faro (FHUs Farol and Al-Gharb). Three hundred and ninety-five patients were interview in terms of their medication regimen. For data collection, a sociodemographic questionnaire, Medication Regimen Complexity Index (MRCI) and chemical parameters (glycated haemoglobin (HbA1C) and capillary glycaemia) were used.

Results

The sample was composed of people aged 65 years and over [75.59 (±6.75)], with a maximum of 93 years (52.9% were women and 47.1% were men). Regarding the MRCI, an average of 15.63 (± 6.84), with a minimum of 5 and a maximum of 32 was found. We verified the existence of a high and statistically significant positive correlation (r = .897; p-value <.001) between the MRCI and the number of drugs prescribed. The study also showed that the increase of the number of drugs prescribed is related to advanced age. For HbA1C, an average of 7.09 (± 1.14), a minimum of 5.3 and a maximum of 12.4 was obtained. It was found that 57.47% of the patients had HbA1C value lower than 7%, 22.78% had values between 7%-7.9% and 19.75% had values higher than 7.9%. In relation to capillary glycaemia, we obtained a mean of 181.13 (± 66.54) with a minimum of 83 and a maximum of 500.

Conclusions

Medication non-adherence and polypharmacy are real problems with negative impact, and potentially fatal. High numbers of medications prescribed are nowadays more common. Unfortunately, the elevated rates of HbA1C and capillary glycaemia values demonstrate that disease management is not effective, so it is urgent to implement programs to help older people self-manage chronic condition.

Paulino Sousa1, Marisa Bailas2

Correspondence: Paulino Sousa (paulino@esenf.pt)

Background

Portugal has a story of almost two decades of computerized information systems use on health area, particularly in the nursing area, with the large-scale implementation of Computerized Information Systems to support nursing practice. We know that the use of electronic health information to support patient care will undoubtedly be responsible for a substantial time-spent on the overall workload of nurses. Too often, we are confronted with nurses’ opinions that the use of computerized information systems (CIS) has a great impact on the overall nurses’ workload (35 to 50% of the global nurses’ workload).

Objective

To identify the perception of nurses on the time spent on CIS in use in a hospital and his impact on the global nurses’ workload.

Methods

A cross-sectional survey was applied to collect data from 148 nurses that use CIS in a hospital (medical and surgical services). This allowed knowing the average percentage of nurses’ perception time spent on the use of SClinico® and other information supports, as well as their distribution by a set of nursing activities in use of the system.

Results

The results showed that nurses consider that time spent on information supports has an average of 42.4% on their total working time: 33.5% on the use of SClínico® (mode and median of 30%; SD ±16.25) and 8.9 % (mode and median of 5 %; SD ±6.67) on nursing records in other non-computerized structures (particularly on paper). These values are overlapping to those presented in some national and international studies. However, results are higher than the real-time shown in studies of Silva (2001) and Sousa and colleagues (2015). Nurses who underwent training processes on Nursing Information System in use (SClínico®) and on ICNP® have differences in time-spent perception on the use of CIS.

Conclusions

A permanent issue in the debate on the use of CIS is the time spent in its use, in particular in the processes of data access, care planning, and record keeping. Nurses have the perception that the time spent on CIS has, in fact, an essential part of nursing practice, but with a high impact on the workload of nurses. However, there are several national and international studies that point out in certain contexts for a lower “real-time” in the global nurses’ workload on the use of computerized information systems.

O60 Pain in people 75 and older: association with activity patterns

Maria C Rocha, José G Sousa, Madalena G Silva

Correspondence: Madalena G Silva (madalena.gomesdasilva@gmail.com)

Background

The prevalence of pain amongst the elderly population (19.5% [1] to 52.8%[2]) may not be disregarded and varies depending on the age range and context. Regardless, pain in this population group has been associated with reduced functional capacity, changes in gait and sleep patterns, depression and reduced social participation [3]. Exercise has often been recommended as an intervention to manage pain in the elderly [4], however long-term adherence to exercise programs is limited [5]. Characterization of pain and exploring its associations with light intensity physical activity may provide a base for discussing alternative clinical interventions for the management of pain in this population group.

Objective

To characterize the presence, location and duration of pain in very old adults and investigate its association with light intensity physical activity.

Methods

A cross-sectional study was implemented with 65 participants aged above 75 years, without cognitive impairment, average age of 79.48 ± 4.98. Presence, location and duration of pain were assessed with the socio-demographic and clinical characterization questionnaire. Light intensity activity was characterized with an Activity Diary. Given de non-normal distribution, dichotomic nominal variables were analysed with the biserial point correlation, and Spearmen’s rho was used for the remaining.

Results

Two thirds (61.5%) of our sample was female, with a low educational level (64.6%). Eighty three percent (n = 54) reported experiencing pain, and from these, 45 (83.3%) had pain for more than one year. Pain was mainly localized in the knees (n = 30) and in the lower back (n = 27). Our sample spent an average of 5h46min per day in sedentary behaviour (< 1.5 METs) and 4h47min in physical activity of light intensity (> 1.5 and < 3 METs, Metabolic Equivalents). Physical activity of low intensity showed a non-significant association with the presence of pain (p = 0.622) nor with the duration of pain (p = 0.525).

Conclusions

We conclude that our sample had a very high prevalence of pain for more than one year, and that this is not associated with the time spent in light intensity physical activity. Further studies are required to provide a better understanding of the association of specific types and location of pain and light intensity physical activity, before it can be promoted as a clinical intervention strategy.

Correspondence: Cristina Simões (cristina-ferreira@iol.pt)

Background

The quality of life (QoL) assessment should include self-report measures in the field of intellectual disability (ID), which provide useful information for personalized support plans and give those with ID the opportunity to express their own perspectives regarding themselves and their individual contexts of life. Nevertheless, the communication and understanding limitations of people with ID can be a barrier to obtaining self-report perceptions. The inclusion of a proxy who knows the individual with ID well has been used to overcome the difficulties of the subjective assessments.

Objective

This proposal aims to explore the factors that could potentially explain the disagreements in QoL assessment of people with ID and their proxies.

Methods

Data were collected from 207 participants: 69 people with ID, 69 practitioners and 69 family members. QoL was assessed by the Portuguese version of the Personal Outcomes Scale. Paired-sample t tests were performed to examine the differences between the mean scores. Multiple regressions were calculated to analyse the determinants that could explain the directional mean difference between people with ID, support staff, and family members.

Results

The personal and environmental characteristics of people with ID (gender, diagnosis, living circumstances, and type of transportation) and the characteristics of practitioners (age, education level, relationship, health status of the person with the ID) had scores with a medium explanation of the disagreements between those participants. The education level of support staff and the health status of the person with the ID had largely explained the discrepancies between people with ID and key workers. Furthermore, the results revealed that four characteristics were major predictors of disagreement between people with ID and family members: the age of the person with ID, the type of transportation, the self-reported health status of the person with ID, and the health status of the person with the ID, as assessed by the family members. Finally, robust factors seemed to explain the discrepancies between practitioners and family members: living circumstances, self-reported health status of the person with the ID, education level of the key worker and education level of family members.

Conclusions

Among other factors, the health status was a major predictor of the different perceptions on QoL assessment. Findings showed that it was possible to predict differences among the three groups of respondents. Strictly speaking, the personal and environmental characteristics of people with ID and proxies predicted the disagreement among the participants.

Correspondence: João Rodrigues (joaorodrigues006@gmail.com)

Background

Health kiosks have been recognized as an effective way to develop knowledge and capabilities of citizens, which can improve the promotion of a healthy behaviour. But several have been the problems that have hindered the large-scale implementation and use of health kiosks, one of the most prominent being the limited acceptance of technology by citizens.

Objective

To identify factors that influence the decision on how and when to use a health kiosk

Methods

This kiosk appears as an innovative project, allowing to monitor anthropometric data (weight) and vital signs (heart rate, oximetry, and blood pressure) on a routine basis or prior to a medical appointment. This was an exploratory study, descriptive and correlational, of a cross-sectional study, with a mixed approach (quantitative and qualitative). In the elaboration of the instruments of data collection, we based on the Technological Acceptance Model (TAM). The analysis of the factors influencing the decision on how and when to use the “health check” was supported by the constructs: perceived utility, perceived ease of use, perceived credibility, and perceived knowledge.

Results

92 citizens accepted to participate in the study. But, 34 refused to use the kiosk (justifying their refusal): they considered “not having enough time to use the kiosk”, most of which verbalized that “they were afraid of losing their medical appointment if they did not hear the call”, “not feeling able to use it”, “not being able to use computers” or “not associating any utility in its use”. The kiosk was used by 58 people who had come to the Health Centre with different objectives: nursing appointment (41.4%), medical consultation (36.2%), administrative contact (13.8%) and the remaining were companions of other health care users (5.6%). Participants were mostly female (70.7%), with an average of 51.3 years (median 51.4, SD±17.6). They reported using technological devices: 94.8% used mobile phones (62.1% has “smartphones”) and 60.3% use computers. Only one participant had experienced prior “health kiosk” use. Users appreciated the utility (94.1%) and easy use (85.7%), as well as the credibility (94.6%) of the kiosk. The perceived knowledge was considered by 80.4% of participants as very good (5.4%) or good (75.0%).

Conclusions

TAM was crucial to understand the strength that some of its dimensions may have as factors that influence the decision on how and when to use the “health kiosk”. Among the citizens who used the health kiosk, mostly found it useful, easy to use, credible and secure.

Acknowledgements

This article is a result of the project NanoSTIMA Macro-to-Nano Human Sensing: Towards Integrated Multimodal Health Monitoring and Analytics, Norte-01-0145-FEDER-000016, supported by Norte Portugal Regional Operational Programme (NORTE 2020), through Portugal 2020 and the European Development Fund.

O63 Delirium care: a survey into nursing perceptions and knowledge

Marta Bento1, Rita Marques2

Correspondence: Marta Bento (marsofia81@hotmail.com)

Background

Delirium is a reversible cognitive manifestation of sudden onset, developing in a matter of hours or days; characterized by a fluctuating course of disturbed attention, memory and perception [1]. Although common, this syndrome is often under-diagnosed and nursing staff are in the best position to recognize, prevent and monitoring delirium symptoms. The current approach to delirium care seems to be insufficient and nurses need to receive more support and guidance providing high quality care [2]. The education of nurses in all care settings can provide the foundation to address this massive international challenge.

Objective

The aim of the study is to assess nursing knowledge, in order to understand and perceive delirious adult/elderly patients.

Methods

In this exploratory study, we applied a questionnaire with closed questions and the sample consisted of 49 nurses working at an ER of a Central Hospital at Lisbon, during the month of December 2017. In order to safeguard ethical issues, we requested approval and informed consent to all participants in the study, with the anonymity and confidentiality of the data being ensured.

Results

The data yielded revealed that there was a high level of knowledge on the definition of delirium (93.8%) and also on the application of the Confusion Assessment Method (86.4%), although in this unit this instrument is not applied routinely. The analysis also reveals that there is a very high level of knowledge about the characteristics of a delirious patients and 100% of the nursing Staff recognize these patients, has not always aggressive. Furthermore, the dehydration and the poor nutrition were identified has risk factors for delirium (95.8% and 91.8%, respectively). On the contrary 63.3% (n = 31) of the respondents assumed that a patient with impaired vision isn’t at increased risk of delirium or neither 22.4% (n = 11) the risk for delirium increases with age 22.4% (n = 11). Equally important, 28.6% (n = 14) of the respondents did not know that patients with delirium present higher mortality rates.

Conclusions

Despite the literature assumes in same hospital settings nurses have insufficient knowledge of delirium-related information, the results of this study evidence an overall positively answered mean score, showing a high level of knowledge of delirium and its risk factors. Nurses have a key role to accurately recognizing and caring for delirious patients given the poor outcomes of untreated delirium.

O64 Nurses' satisfaction with the use of Health Information System in Funchal hospitals

Plácida Silva1, Paulino Sousa2, Élvio Jesus1

Correspondence: Plácida Silva (placidasilva@hotmail.com)

Background

The evaluation of the Health Information System (HIS) is a fundamental activity to determine the success of the system and guarantee the continuity of its use. That is why it is important to know the true impact on the use and satisfaction of its users. In recent years, we have seen in Portugal different studies on nurses’ satisfaction with HIS use. However, none of the studies refers user satisfaction with the HIS structure that supports the practice of nurses in the Autonomous Region of Madeira (ARM).

Objective

To identify dimensions and level of nurses' satisfaction with the HIS in use.

Methods

A cross-sectional, exploratory and descriptive study was carried out in the ARM, in inpatient units of Funchal Hospitals. Data collection was supported by the application of the “User Satisfaction Questionnaire for Nursing Information Systems” based on DeLone & McLean Model of Information System Success (2003). This instrument uses a 5-point Likert scale structure with a semantic differential operationalized “1-unsatisfied” and “5-very satisfied”, in an increasing logic of level of satisfaction, in which there is no neutral intermediate point.

Results

The adherence rate of the study population was 50.5%, corresponding to a sample of 283 nurses. The exploratory factor analysis process was reduced to 5 factors, similar to previous studies which resulted in the following dimensions: 1) information sharing; 2) structure and content of information needed for decision-making; 3) support structures and HIS contributions; 4) Security, data protection and technical support; and 5) graphical data presentation. The dimension “satisfaction with access to necessary information for decision making” with an average value of 3.13 (Median 3, SD ±0.70), reports the area where the higher level of satisfaction is observed. The dimension “support structures and HIS contributions” has the lower average value of 2.81 (Median 2.8, SD ±0.64), The overall “nurses’ satisfaction with NIS in use” was 2.96 (±0.57), with a median of 3 on a Likert scale. This overall result reports a good level of nurses’ satisfaction with the HIS that they use.

Conclusions

This study allowed us to identify dimensions that incorporate the DeLone & McLean Model of Information System Success. At the same time, it has allowed us to identify factors that determine the level of satisfaction of the nurses with the HIS that they use and being able to determine the “use” and “intention to use them”.

Correspondence: Sandra Ventura (scventura@ipg.pt)

Background

Consumption of psychoactive substances is widespread among young adolescents and young adults and constitutes a public health problem with significant consequences for individuals and societies throughout the world. The main consequences depend on the consumption pattern of the substance used and may result from the immediate or cumulative toxic effect of the substance consumed, from intoxication or psychoactive effects, or from addiction or addiction syndrome. Particularly alcohol and tobacco consumptions are the second and third risk factors of morbidity and mortality in Europe. Harmful use of alcohol, under acute and chronic conditions, can have serious developmental and social consequences, including violence, neglect and accidents, as well as health problems. Tobacco use also has negative consequences on health and social life.

Objective

In this context, the objective of this study was to characterize the consumption of psychoactive substances by students of the Superior Health School of the Polytechnic Institute of Guarda and to reflect on prevention strategies to be implemented to dissuade and reduce consumption among students.

Methods

A questionnaire was applied to the students and we collected 261 answers, from a total of 175 students of the Nursing Course and 88 of the Pharmacy Course.

Results

The results obtained indicate that the most consumed substances were, in descending order: alcohol, tobacco, psychoactive drugs and illicit substances. Regarding alcohol experimentation, it was found that 76.6% of nursing students and 85.2% of pharmacy students had already consumed alcohol. These data were higher than the national prevalence throughout life in 2015 (71%). The consumption of alcohol by nursing students (74.3%) and by pharmacy students (89.8%) was also higher than the consumption of Portuguese young people between 13 and 18 years old (62%). Tobacco consumption by nursing and pharmacy students were of 51.6% and 56.8%, respectively, both higher than the national data of 40%. The consumption of tobacco was of 39.3% by nursing students and 45.5% by pharmacy students, and it was also higher than the 30% reported for national consumption. Illicit substances were the least consumed, with a prevalence throughout life of 13.3% and 9.0%, respectively, by nursing and pharmacy students, inferior than the national data (19%). Cannabis was the illicit substance more consumed by either nursing and pharmacy students.

Conclusions

These results indicate that there is work to be done in the prevention and dissuasion of consumption of psychoactive substances by our student community.

O66 Diabetes Mellitus as a key indirect causal factor for pressure ulcer development

Pedro Sardo1,2, Jenifer Guedes2, José Alvarelhão1, Elsa Melo1

Correspondence: Pedro Sardo (pedro.sardo@ua.pt)

Background

Ensuring patient safety in healthcare is a challenge [1-6]. With the growing Diabetes Mellitus incidence, healthcare professionals and planners are encouraged to pay further attention to the major complications of this disorder [3]. According to EPUAP and EWMA [3], poor circulation and infection are among the most common complications that effect diabetic patients. A recent pressure ulcer conceptual framework [7, 8] identified Diabetes Mellitus as a key indirect causal factor (and poor perfusion as a direct causal factor) for pressure ulcer development and encourages the development of clinical studies that explore the correlation(s) between these specific risk factors and pressure ulcer development.

Objective

To identify the influence of Diabetes Mellitus on pressure ulcer development in adult patients admitted to medical and surgical wards in 3 Portuguese hospitals.

Methods

Cross sectional design survey developed on June 16th, 2015 with 236 adult patients admitted to medical and surgical wards in 3 Portuguese hospitals. The study was performed after Hospital Council Board and Ethics Committee approval (Reference Number 049688). Data were analysed using SPSS v25.0. Descriptive statistics were calculated for the sample characterization. Pressure ulcer risk, prevalence and incidence were calculated according to EPUAP statement [9]. Odds ratio (OR) was calculated by univariate logistic regression.

Results

This study included a sample of 236 participants with the median age of 76 years (Q1 = 62 years; Q3 = 83 years). The majority of the participants was male (56.8%), admitted trough the emergency service (80.9%) and stayed in medical units (60.2%). On the day of the survey, 121 (51.3%) participants were classified as “high risk of pressure ulcer development” (Braden Scale score ≤ 16); 45 (19.1%) participants had at least one pressure ulcer documented; 7 (3.0%) participants developed a new pressure ulcer since the admission in inpatient setting; and 67 (28.4%) participants had Diabetes Mellitus. Using a univariate logistic regression model, the odds of developing a pressure ulcer during the length of inpatient stay were significantly higher for the participants with Diabetes Mellitus with OR = 6.73 (95% CI:1.27-35.61, Nagelkerke R2 = 0.103) compared to the other participants.

Conclusions

This study supports the pressure ulcer conceptual framework proposed by Coleman, Nelson [7] and Coleman, Nixon [8], showing that Diabetes Mellitus is a key (indirect) causal factor for pressure ulcer development in inpatient settings. However, further studies are needed in order to understand the influence of Diabetes Mellitus on skin and tissue (poor) perfusion and consequently on pressure ulcer development.

Acknowledgements

Thanks are due to “Centro Hospitalar Baixo Vouga, EPE” (Portugal), particularly to the Nursing Council Board, head nurses and to the nurses that recorded the data in the medical and surgical services of Águeda Hospital, Aveiro Hospital and Estarreja Hospital.

Correspondence: Luciane Cabral (luciane.pacabral@gmail.com)

Background

In Brazil and in the world, the growth of the elderly population is an indisputable reality, so it is necessary to identify the factors that favour the sickness of this age group, with emphasis on the fragility, which can be defined as a syndrome which presents innumerable causes and is characterized by a set of clinical manifestations, such as decreased in strength, endurance and physiological function, collaborating to make the individual more vulnerable to addiction and/or death [1].

Objective

In view of the above, the present study aimed to evaluate the fragility syndrome of the elderly hospitalized in a teaching hospital.

Methods

A cross-sectional study, carried out with a convenience sample of 107 elderly patients admitted to the emergency room, at the medical, surgical and neurology clinic of the medical, surgical and neurology of a teaching hospital in the Campos Gerais region, from October 2016 to April 2017. Data collection included the application of the Mini Mental State Examination [2] for cognitive screening and Edmonton Fragility Scale [3], culturally adapted to the Portuguese language in Brazil [4]. Data were analysed using Stata®12 software. The association was verified through simple linear regression (Fisher's F and Student's t tests), significance level of p = 0.05. The project was approved by the Ethics Committee of the State University of Ponta Grossa (CAAE nº 34905214.0.0000.0105).

Results

The results showed a predominance of females (58.9%), married (61.0%), low schooling (71.0%), living with spouse (n = 42, 39.3%), considered their income satisfactory (50.5%). The mean age of participants was 70.3 years. Regarding clinical variables, 99.1% had a disease, 36.5% used medication and 50.5% reported hospitalization in the last 12 months. The fragility evaluation identified that 19.6% of the elderly were nonfragile, 24.3% apparently vulnerable, 26.2% had mild fragility, 15.9% moderate and 14.0% severe. It was found that any level of schooling used medication (p = 0.001), solitude (p = 0.001), loss of urine (p = 0.001) and hospitalization in the last 12 months (p = 0.001) and was associated with the fragility syndrome.

Conclusions

The importance of early detection of the syndrome is emphasized through the use of an instrument that is valid, reliable and easy to apply by the health team, such as the Edmonton Fragility Scale. The results presented can support the planning of health care, considering the characteristics and demands of the elderly who are hospitalized, thus contributing to improve the quality of care provided.

O68 Braden Scale accuracy tests

Pedro Sardo1,2, Jenifer Guedes2, José Alvarelhão1, Elsa Melo1

Correspondence: Pedro Sardo (pedro.sardo@ua.pt)

Background

Pressure ulcers management is a challenge [1-6]. Portuguese guidelines [7] encourage the implementation of regular pressure ulcer risk assessments through the application of the Braden Scale and the patients’ categorisation into two levels of risk (defined by cut-off point of 16). However, the development of pressure ulcer(s) is complex and multifactorial [8] and whenever the Braden Scale score falls below 18, each patient functional deficit and/or risk factor should be individually addressed [9].

Objective

To analyse the Braden Scale accuracy tests in adult patients admitted to general wards in a Portuguese hospital during one year, using different cut-off points.

Methods

The study was designed as a retrospective cohort analysis of electronic health record database from 6,552 adult patients admitted without any pressure ulcer in medical and surgical wards in a Portuguese hospital during 2012. All data were extracted after Hospital Council Board and Ethics Committee approval (Reference Number 049688). Braden Scale Accuracy Tests (BSAT) such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the curve (AUC) were assessed [10].

Results

The study included 6,552 participants with a mean age of 64 years and 6 months. The majority of participants was male (52.6%); admitted trough emergency service (69.1%); in surgical (64.5%) units. During the length of stay 153 (2.3%) participants developed (at least) one pressure ulcer. Considering the cut-off point of 15, the BSAT showed: sensitivity of 50%(95%CI:42%-58%); specificity of 82%(95%CI:81%-83%); PPV of 6%(95%CI:5%-8%); NPV 99%(95%CI:98%-99%); and AUC of 66%(95%CI:61%-71%). Considering the cut-off point of 16, the BSAT showed: sensitivity of 63%(95%CI:55%-71%); specificity of 74%(95%CI:73%-75%); PPV of 5%(95%CI:4%-7%); NPV 99%(95%CI:98%-99%); and AUC of 69%(95%CI:64%-73%). Considering the cut-off point of 17 the BSAT showed: sensitivity of 78%(95%CI:71%-84%); specificity of 63%(95%CI:61%-64%); PPV of 5%(95%CI:4%-6%); NPV 99%(95%CI:99%-99%); and AUC of 71%(95%CI:67%-74%).

Conclusions

Although our BSATs follow the trend of the results found in a recent systematic review [11], they showed some of the limitations of the patients’ categorisation into two levels of risk according to a specific cut-off value. Like Braden [9], we believe that this assessment tool should be supplied with clinical judgment in order to identify patients’ specific risk factors that should be individually addressed with accurate preventive interventions. Furthermore, in order to develop evidence-based practice, we should create a minimum data set for pressure ulcer prevention, assessment and documentation [12-14] based on patients’ characteristics, international guidelines [15] and conceptual frameworks [12-14].

Correspondence: Maria C Lamas (mariaceulamas@gmail.com)

Background

Primary school students usually have very little previous knowledge about a number of educational issues. So, it is important to create moments where the students can tell whatever they know about a subject, in order to make an additional scientific explanation. The program of the 1st cycle of basic education aims to develop an attitude of permanent research and experimentation, and the part “The health of your body”, to produce knowledge and the application of norms of body hygiene [1]. However, the contents expressed in the textbooks for these levels of education do not justify the need for children to adopt these hygiene habits, which must be acquired as early as possible, to be a systematic routine throughout life. On the other hand, it allows to eradicate some of the alternative conceptions that some 1st cycle students present on some issues [2], as the notion about the morphological view of microorganisms away from reality, idealizing them similar to animals [3,4,5]. There is evidence that children are able to learn about microorganisms at this age [3,4,5] and it is desirable that it occurs as early as possible, avoiding late conceptual changes that are difficult to reconstruct in their entirety [4]. For some authors [6,7], children should realize that the knowledge learned in the classroom can be applied in their daily lives.

Objective

In this context and with the purpose of promoting scientific and critical literacy, we developed an activity about hand hygiene because handwashing should be learned and be a properly reasoned behaviour.

Methods

The activities were developed by all 26 students in the class A, 2nd grade of the School EB1/JI Picua. The students' age ranged from 7 to 8 years, with 54% (14) boys and 46% (12) girls. It started with the question “Handwashing: Why, When, How?”. According to the conceptions expressed by the students the appropriate theoretical contents were presented in a gradual and interactive way. This was followed by the experimental procedure with permanent monitoring and support based on the succeeding steps: role-playing stages for proper handwashing; applied activity; listing expected results; observation of cultures and microscopic observation of microorganisms, recording and reflection about the results achieved.

Correspondence: Edite Teixeira-Lemos (etlemos2@gmail.com)

Background

About a third of community-dwelling adults age 65 and older fall each year. Accidental falls are a cause of fractures, traumatic brain injury, and even death. They can also lead to restrictions in participation, eventually resulting in loss of independence in normal activities of self-care. Falls in older adults are multifactorial and can be caused by medical conditions, cognitive impairment, medications, and home hazards. Therefore, a single identifiable factor may account for only a small portion of the fall risk in the community-dwelling elderly population, stressing the need for a multifactorial evaluation in this population.

Objective

Identify the risk of accidental falls in an independent elderly population by using functional tests that can be routinely applied in clinical practice and evaluate the influence of medication in the risk of falling.

Methods

The sample consisted of 108 individuals who attended a health care facility between October 2016-January 2017. Inclusion criteria: age 65-85, Functional Independence Measure (FIM) ≥ 120 and Timed Up and Go (TUG) ≤ 12s. Individuals with serious cognitive or motor impairment were excluded. A form was filled with sociodemographic data, daily medication and history of falls. Handgrip strength was measured. Fear of falling was assessed using the Activities-specific Balance Confidence (ABC) scale. Participation was evaluated using the Activities and Participation Profile related to Mobility (APPM). Informed written consent was obtained for all participants.

Individuals with low balance confidence showed higher restrictions in participation related to mobility. All of the functional parameters evaluated in this study were affected by age. These results stress that a comprehensive and multifactorial evaluation of risk factors for falls in older people and the adoption of interventions tailored to this age group, which could include a reassessment of their usual medication, are necessary in order to reduce fall risk and fall-related injury.

Correspondence: Soraia Teles (teles.s.soraia@gmail.com)

Background

For the last 10 years, Ambient Assisted Living (AAL) solutions have been conquering an important place in policies addressing economic and social challenges resulting from population ageing [1]. The AAL concept corresponds to a new paradigm building on ubiquitous computing devices and new interaction forms to improve older adults’ health, autonomy and security [2]. In spite of promising contributions of AAL solutions for ageing in place, low adoption by end users was reported [3-5]. This is thought to result from the intersection of technology features, user characteristics and attitudes [6]. Research has suggested that among attitudinal factors preventing adoption of these solutions there is a lack of trust, substantiated, among other factors, by user’s concerns about data security and privacy [5,7-10]. Digital advisory services for AAL solutions have to foster not only user’s trust on the advisory service per se, but also on AAL products and services and the web communication within a community.

A qualitative approach was used. Thirty-eight semi-structured interviews with AAL stakeholders– older adults and informal caregivers, businesses and government representatives– were conducted in six European countries (Austria, Switzerland, Belgium, Netherlands, Portugal and UK). The data was analysed using the matrix method [11].

Results

For the uptake of AAL digital advisory services, the level of user’s trust in the system seems to be critical. Features emerging as crucial to foment trust in digital advisory services were threefold: presence of security and privacy cues; personalization-related cues; and community features, including availability of client-to-client interactions and feedback given by reliable peers or experts. Older adults expressed their interest in becoming active in a digital community if provided an environment perceived as secure and, simultaneously, easy to use.

Conclusions

Building trust in AAL digital advisory services depends on multiple and complex user requirements. Security issues have shown to be of utmost relevance due to the nature of information exchanged, i.e. personal, health-related and sensitive data, and generational preferences, with privacy and security cues having primacy for ‘Baby Boomers’, as supported by previous research [12]. These findings stress the need for a paradigm shift towards user-centred and user empowering models and mechanisms for securing the interaction with systems (e.g. authentication mechanisms, access control models and visualization techniques; e.g. SoTRAACE model) [13].

Acknowledgements

The authors would like to acknowledge the co-financing by the European Commission AAL Joint

Programme and the related national agencies in Austria, Belgium, the Netherlands, Portugal,

Correspondence: Marisa J Cardo (marisacardo@gmail.com)

Background

The Intra-Hospital Emergency Team (IHET) has emerged to respond to situations of clinical deterioration of hospitalized patients, being nurses the fundamental links in the activation. During a situation of clinical deterioration with the need for IHET intervention, the actions of nurses in inpatient services depend on many factors. To facilitate the activation and effectiveness of this team, nurses must have self-confidence to carry out the activation of IHET. Nurses believe that IHET’s intervention is important in the pursuit for safe care and that the most important ingredient for the effective use of this team is the nurse.

Objective

This study aims to evaluate the level of self-confidence for emergency intervention of nurses and to identify the nurses’ perceptions of the importance of the IHET.

Methods

This correlational study included 129 nurses from the Centro Hospitalar de Leiria who answered a questionnaire about the perception of IHET importance and the self-confidence scale for emergency situations validated for the Portuguese population by Martins et al. (2014), which consists of 12 items with Likert type responses. Pearson correlation and t-student were used for data analysis.

Results

In this study, 84% were female nurses with a mean age of 39.70 ± 9.02 years, with an average professional experience of 16.97 ± 8.95 years, and the majority with training in the emergency area (94%). The mean self-confidence level of the nurses was 3.263 ± 0.571, for a maximum of 5 points. Regarding the nurses’ perception of importance of the IHET, a positive tendency was observed (results ranged from 3.426 ± 0.570 to 4.775 ± 0.419). A partial relation between the professional experience (r = 0.25; p = 0.004), the training (t = 6.143; p ≤ 0.0001) and the level of self-confidence (r = -0.205; p = 0.020) with the level of perception is highlighted.

Conclusions

In this study, regarding the self-confidence for emergency intervention, the nurses demonstrated confidence, albeit modestly. Likewise, they presented a tendency towards positive agreement regarding the importance of IHET. Of note, the higher the experience of the nurses, the greater the importance attributed to the IHET. Finally, it was verified that the higher the nurse's self-confidence index, the lower the feeling of insecurity in an emergency situation.

Correspondence: Catarina Caçador (cacasabel@hotmail.com)

Background

Elderly are particularly vulnerable to nutritional change deficits. Malnutrition in elderly patients is frequently underdiagnosed [1] and it has a large number of negative consequences on health and quality of life [2]. Even in industrialized countries undernutrition is becoming an alarming phenomenon, especially involving elderly institutionalized subjects. Few studies have focused on the relationship between patient’s nutritional assessment and a severity of cognitive impairments, comorbidity and functional status in institutionalized older adults.

Objective

In the present study we evaluated the relationship between functional disability, cognitive impairment and nutritional status.

Methods

This was an observational study with data collected from residents living in institutions in the district of Viseu (centre of Portugal). Inclusion criteria were: subjects aged 65 or older, living in institutions, that voluntarily accepted to participate in the study. All of the 216 subjects studied underwent multidimensional geriatric assessment. A form was filled with sociodemographic data and the nutritional state was assessed with the Mini Nutritional Assessment (MNA), whereas cognitive performance was evaluated by the Mini-Mental State Examination (MMSE). The functional state was assessed by Barthel Index (BI). Statistical evaluations (p < 0.05) were based on Qui-square tests between Barthel Index (BI), Mini Mental State Evaluation (MMSE), Body Mass Index (BMI) and Mini Nutritional Assessment (MNA) scores. Statistical evaluations (p < 0.05) were based on Qui-square tests between BI, MMSE, BMI and MNA scores.

Results

A cognitive impairment in MMSE performance was displayed in 39.4% patients. Slight disability occurred in 69.4% of the residents, 24.1% were independent in activities of daily living and only 6.5% of the seniors had moderate dependence. There was a proportional increase of the cognitive impairment of the elderly (p ≤ 0.001) with increasing dependence. According to MNA, 27.8% of the elderly were at risk of malnutrition and 71.3% showed no nutritional problems. Statistical analysis showed that dependence increased the risk of malnutrition.

Conclusions

A close relationship between malnutrition and functional dependence has been obtained. Both tests, MNA and BI, are positively associated. The scores of BI can help to determine who may be at risk of poor nutrition.

Carlos Vilela1,2, Paulino Sousa2, Filipe Pereira2

Correspondence: Carlos Vilela (carlosvilela@esenf.pt)

Background

The evaluation of nursing care is an imperative for the continuous development of quality improvement and for the cyclical redefinition of action plans that correspond to the real needs of the population. In the specific case of the Integrated Continuing Care Teams (ICCT), inserted in the National Network of Continued Integrated Care of Portugal, it is justified the use of a panel of indicators of health gains “Sensitive to Nursing Care”, given the nature of the services provided in these units, which helps to measure the clinical results obtained.

Objective

1) To identify the main nursing care needs of ICCT clients; and 2) Identify health gains sensitive to nursing care related to those needs.

Methods

Based on the definition model of indicators “sensitive to nursing care”, we developed a quantitative study-exploratory, descriptive and correlational, using the analysis of the nursing documentation available in Information Systems in use, in a convenience sample of 217 cases, attended in four ICCT of the northern region of Portugal, from October 2012 to May 2013.

Results

From the analysis of 9,258 documented nursing diagnoses, it was possible to generate eight “types” of health gains indicators. Five related to the dependent person and three referring to the family caregiver (FC). Here the great incidence of the care provided in these ICCT was revealed, where the Gains in autonomy/independence in the universal requirements of self-care and Gains in knowledge of the FC were the most representative areas of the care provided. Then, came the domains of Gains in the evolution of nursing diagnoses of the dependent person (“others”) and Gains in knowledge of the dependent person. Approximately 10% of the results computed were in areas that focused on Gains in FC performance (11.20%), Gains in performance of dependent persons (10.43%) and Gains in the prevention of Ulcers of Pressure (9.32%). With an order of magnitude in the order of 3.30% emerged the field of indicators related to Gains in the evolution of nursing diagnoses centred on the Role of Care Provider.

Conclusions

Reflecting on these results allows a more effective approach to the representation of nursing care in the evaluation of quality and, certainly, a better redefinition of the panel of indicators at the national level, with “sensitivity” to the nursing work developed by ICCT.

Correspondence: Inês Domingues (inesfsdomingues@gmail.com)

Background

There is a growing prevalence of disability worldwide, which indicates an increasing number of persons who might benefit from assistive technologies. Several studies showed positive effects of the use of assistive technologies on activity and participation of adults with mobility impairments [1, 2], as well as on psychosocial factors [3, 4].

Objective

The purpose of this study is to assess the psychosocial impact of the powered wheelchair, evaluating its repercussions on the social participation of its users.

Methods

Design - Observational, descriptive, cross-sectional study; Setting – All data was collected from May to October 2017; Participants - 30 powered wheelchair users with mean age of 40.63 years old (60% male) with diverse medical conditions (SCI, TBI, CP, among others); Main outcome measures - Interviews were conducted by an independent researcher using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST), the Psychosocial Impact of Assistive Devices Scale (PIADS) and the Activities and Participation Profile Related to Mobility (PAPM), in addition to demographic, clinical and wheelchair-related questions.

Results

Participants were quite satisfied with both the assistive technologies and the related services, with the lowest QUEST scores belonging to those who had been using their wheelchairs for a longer period of time. PAPM scores revealed significant restrictions in participation (6.7% of participants with mild restrictions, 56.7% with moderate restrictions and 36.7% with severe restrictions), with a worst participation profile also among the users who had the wheelchairs for a longer period. The most satisfied users were the ones with better performance in terms of social participation. PIADS scores showed a positive impact of the powered wheelchairs in all subscales, with the following average scores: total 1.37, competence 1.39, adaptability 1.32 and self-esteem 1.38. The psychosocial impact, in terms of adaptability, was higher among users who transitioned from a manual wheelchair to a powered wheelchair compared to those who already had a powered wheelchair previously (1.85 vs 1.10; p = 0.02).

Conclusions

There was an overall positive psychosocial impact of powered wheelchairs, and, therefore, an increase in the quality of life of the users. Adaptability to the device seems to be the most contributing factor to social participation.

Correspondence: Rita MF Leal (ritamariaferreiraleal@gmail.com)

Work is known to be an obstacle to breastfeeding (BF) continuation [1–5].

Objective

To analyse if there is a relationship between the employment status of the mother, the age of the child when she returns to work, the level of difficulty in reconciling work with BF and BF duration.

Methods

An observational, descriptive-correlational and cross-sectional study was conducted. The population comprised mothers who had a biological child in 2012 and 2013 in the Centre region of Portugal. A non-probabilistic sample (n = 427) was collected using an online questionnaire with snowball effect from November 2015 to September 2016. Data was analysed using SPSS software.

Results

Most women had difficulties in reconciling work with BF (72.5%). Of these, 26.6% said that conciliating work and BF was “very difficult” or “difficult”, while 73.4% said they had “some difficulty” or “very little difficulty”. Job status (employed versus unemployed) did not present a statistically significant relationship with BF duration. As to the age of the child when the mother returned to work, we verified a statistically significant relationship (p = 0.001) with BF duration. The level of difficulty the mother experienced in reconciling her job with BF also presented a statistically significant relationship (p = 0.002) with BF duration.

Conclusions

The majority of mothers reported difficulties in reconciling work with BF. Women who returned to work before their child was 6 months old had shorter BF duration. This reinforces the need to explore family’s timely expectations, and plan strategies to promote an effective management of work and BF. In this context, we believe there is a need to establish in our culture jurisdiction policies that favour BF and work. Health professionals should act as mediators in the definition of family-oriented health policies. In this case, the extension of a parental leave for mothers up to 6 months postpartum, the existence of a place at work where breastfeeding mothers can extract and conserve their breastmilk or the existence of day-care centres in the workplace, in accordance to the Global Strategy for Infant and Young Child Feeding [6,7], may prolong BF duration and ease mothers difficulty in managing BF when returning to work.

References

1. Lynch S. Breastfeeding and the workplace. Community Pract. 2016;89(6):29–31.

4. UNICEF. From the First Hour of Life: Making the case for improved infant and young child feeding everywhere PartI: Focus on Breastfeeding [Internet]. New York; 2016. Available from: http://www.unicef.pt/docs/pdf_publicacoes/FromTheFirstHourOfLife-Part1.pdf

Correspondence: Francisca MMC Pinto (franciscampinto@gmail.com)

Background

Breast cancer survivors (BCS), and other cancer patients, are digital social networks users; have their personal blogs where share their life/disease experiences after being diagnosed for cancer [1, 2]. Research on blogging activity among BCS is scarce and suggests that is a multifaceted activity with several purposes: self-management of emotions, problem-solving, and sharing information [3]. But the question remains: what health information is share by BCS in blogosphere?

Objective

The present work reports the results of a study that explored personal blogs of BCS who lives in Portugal, with focus on written health information that was posted and/or commented.

Methods

A qualitative study design and thematic content analysis. Blog selection by snowball strategy that included 3 phases: I) phase 1: first 20 search results on Google, with Portuguese keywords “blogues cancro da mama”; II) phase 2 and 3: links to other blogs that are present on each blog selected on phase 1 and 2, respectively. Blogs included for analysis met all criteria for inclusion: I) personal blog of women self-identified with a breast cancer diagnosis; II) blogger profile allows to confirm residence in Portugal; III) blog is public domain; IV) blog must present data related to post-primary treatment phase. Data collection was done between March–November, 2017. The scope analysis started on first post after finish primary treatment for breast cancer and ended in blog’s last post at time we finished to read it.

BCS use personal blogs to share difficulties, uncertainties and to search for information support to manage their health condition. Having access to useful information and education may help BCS manage uncertainty in illness, improve health literacy and self-efficacy to manage health condition. This study alerts health professionals to pay attention to BCS information and emotional needs.

Correspondence: Ricardo Vardasca (ricardo.vardasca@fe.up.pt)

Background

According to the Portuguese Society of Diabetology, about 415 million (8.8%) of the worldwide population was diagnosed with Diabetes Mellitus in 2015. Being the Portuguese population incidence of 1 million people (13.3% of the total population), with a national annual total estimated cost of 1.7 billion euros with this condition. One in each four patients of DM develop Diabetic Foot Ulcer (DFU) in their lifetime, ending some in amputations and consequently in death [1]. Furthermore, the Directorate-General of Health estimated that in 2016, the prevalence of DFU was of 11.5% in the Portuguese population [2]. Throughout the years, DFU assessment tools have been created, such as: I) scales, which depend on visual examination being highly subjective; II) invasive methods that use manual procedures for depicting the shape, area, depth and volume of wounds, that are time consuming, susceptible to human errors and can lead to wound contamination [3]; or III) non-invasive methods such as optical based techniques which provide three-dimensional information about the lesion, which are expensive, time consuming and require user training [4]. Therefore, more objective measures are required.

Objective

This research study aims to create an objective and simple methodology based in a mobile application which incorporates an algorithm that characterises DFU ulcers providing information about its area and tissue colour composition.

Methods

An Android mobile application was developed, tested and evaluated in 200 diabetic foot ulcers, after signing the informed consent and the procedure being explained to patients. The study was approved by the ethical committee of Centro Hospitalar do Porto.

Results & Conclusions

The use of this new android mobile app showed a high correlation with the traditional clinical assessment (r2 = 0.97), reducing subjectivity, avoiding wound contamination probability and smaller costs when compared to conventional solutions.

Correspondence: Olívia R Pereira (oliviapereira@ipb.pt)

Sleep disorders are one of the most relevant clinical symptoms in adults, with increasing prevalence throughout life, reaching in large scale the elderly population.

Objective

The present study aimed to characterize sleep disorders in the elderly and its pharmacological therapy.

Methods

A cross-sectional study was performed through application of a questionnaire to 381 elderlies in pharmacies of Braga, Bragança and Porto cities. Descriptive statistics were used, as well as univariate and multivariate statistical analysis, with a significance level of 5%.

Results

Elders were most from female gender (60.1%), aged between 65 and 74 years (49.6%) and lived in rural areas (73.4%). Just 36.5% of the elderly practice physical exercise and an important amount of elderly drink coffee and tea (68.8% and 73.2%, respectively). Concerning sleep characteristics, the elders go to bed between 6 p.m. and 2 a.m. and about half of participants (52.8%) go between 10 p.m. and 12 a.m. Approximately one third had difficulty in falling asleep (38.1%), especially the elderly from the region of Bragança. During sleep, a large proportion of the elderly reported having sleep stops (78.2%) usually for 15-30 minutes and 26.5% reported waking up twice during the night. Taking into account that the time of delay to sleep is an important factor, in the present study, this was statistically related with the gender (p = 0.003) and with taking medication to sleep (p < 0.001). The same two factors are statistically related with “wake up during the night” (p = 0.046, p = 0.003, respectively). 40.7% of the surveyed elderly have been diagnosed with sleep disorders, mainly insomnia (19.7%) following by restless legs syndrome (3.4%), excessive drowsiness (2.9%) and sleep apnoea, sleep-walking and narcolepsy (about 1%). It is important to refer that among the elderly, that assume to suffer from sleep disorders, just 40.7% have been consulted by a physician. Of those who consulted a doctor, 21.3% of the elderly were advised to change their lifestyle habits, such as, to avoid heavy meals before bedtime, to establish a sleep routine, to lie down only when he/she is sleepy and to practice physical activity. Concerning the pharmacological therapy, 41.7% take medication for sleep disorders, 9% take medication without consulting a doctor, while 32.5% elderly people take medication after consulting a doctor. From these, the most used are benzodiazepines such as alprazolam (12.5%), diazepam (8.6%), lorazepam (4.5%) and brotizolam (3.7%).

Conclusions

Sleep disorders are frequent in the elderly population. It is necessary to raise awareness in this population group, which associates sleep problems to age.

Correspondence: Rogério Rodrigues (rogerio@esenfc.pt)

Background

Disability in old age may pose barriers to the achievement of goals and the ability to carry on roles that are important to a person. Knowledge about the functional disability in physical and mental areas in old people is crucial for the planning of interventions by the health technicians.

Objective

To evaluate functional physical and mental abilities of community-dwelling elderly for planning health care and the implementation of services.

Methods

Quantitative descriptive-correlational study of the project “The oldest old: Coimbra’s ageing study” PTDC/CS-SOC/114895/2009 [1]. Sample constituted by 202 elderlies from a population of 808 (three age groups: 65-74; 75-84 and ≥ 85 years old), obtained in a randomized and probabilistic trial, from the files of users of a Health Centre, after ethic commission approval. As instrument and method of data collection was used the QAFMI (Portuguese version of the Older Americans Resources and Services), to evaluate the functional status, in terms of physical and mental health. Data analysis: a) descriptive analyses on the most common pathologies, their limitation and medication consumption; b) functional evaluation using the score given by the computer software based on the model of QAFMI.

Results

As main results we point out, the pathologies with major interference in physical activities, which are chronic bronchitis, skin disease, arthritis or rheumatism, effects of stroke and circulation troubles. Related to the consumption of medication, it was observed that for the most cited pathologies (hypertension and cardiac problems) there is a great percentage of consumption. Others (arthritis or rheumatism) have a lower prescription. There was no statistically significant difference for physical health, in the comparative study between genders. There are differences between the age groups, with lower scores for the oldest. Related to mental functional abilities, there is a statistically significant difference for the diverse age groups, with an increase of impaired capacity for the oldest. For the whole of the sample gender differences exist, being worst scored the women.

Conclusions

Women and the oldest, in general, appear as the ones that present lower functional physical abilities. The classification by the QAFMI model, regarding the area of mental health, reports the approach of cognitive decline and perception of memory loss. Like in other studies, differences were found between genders, resulting in worse scores for women.

O81 Adherence to therapy in elderly

Ana Rodrigues, Clara Rocha, Jorge Balteiro

Correspondence: Jorge Balteiro (balteiro@estescoimbra.pt)

Background

In recent decades, the elderly population has grown significantly, leading to an increase in the number of chronic diseases and, consequently, to an increased need for polymedication for disease control. Polymedication means the use of multiple medications, which can cause adverse reactions/drug interactions that increase depending on the number of medications administered. In elderly with high number of pathologies associated or not with age, complex therapies are instituted which may lead to non-adherence to therapy. This situation can impair the aim of treatment, worsen the disease, add errors to diagnosis and treatment itself, or even lead to therapy failure.

Objective

The objective of the present study is to assess the adherence to therapy in elderly institutionalized during the day and investigate the main factors that influence it.

Methods

The study was conducted with the collection and processing of questionnaires, consisting of 3 parts: demographic characterization (e.g., age, gender, marital status); therapeutic characterization (amount of daily medications and treatment regimen) and evaluation of adherence to therapy by adapting the scale of measurement of adherence to treatment (MAT). The study sample was made up of 51 elderlies institutionalized during the day.

Results

It was observed that 98% of seniors join the instituted therapy: 37.3% showed a level of 5 therapeutic membership, approximately 49% showed a level of accession of 6 and only 14.9% expressed below. Of the factors studied as susceptible of influencing therapeutic membership, it was only found that oblivion is the conditioning factor associated with the recommended therapy (p = 0.047), affecting the levels of membership.

Conclusions

The results obtained allowed to conclude that the high levels of membership can be associated to the fact that the elderly were institutionalized during the day, having support available. Another possible explanation is the fact that the same live with family, being also accompanied during the night.

Keywords

Adherence to therapy, Elderly, Polymedication, MAT.

O82 Ionizing radiation effects in a bladder and an esophageal cancer cell lines

Correspondence: Fernando Mendes (fjmendes@estescoimbra.pt)

Background

Oesophageal cancer (EC) and bladder cancer (BC) share the same embryonic origin (endoderm) and according to the latest numbers, EC is the eighth and BC is the ninth most frequently diagnosed cancers worldwide. Radiotherapy (RT) is currently used in the treatment of both types of cancer [1–4].

Objective

Assessment of the effects of ionizing radiation (IR) on cell lines of EC (OE19) and of BC (HT1376), namely viability and cell proliferation, characterisation of cellular death type and cell cycle, as well to establish survival factor and determination of the aggression model, after different radiation dose exposure to calculate half lethal dose (DL50).

Methods

Cell lines were cultured and exposed to single-shot doses of X-rays from 0.5 Gy to 12.0 Gy, except control cells (0.0 Gy). Cell viability and proliferation were assessed by trypan blue assay. The proliferation index determination was performed by immunocytochemistry trough Ki-67 expression. Flow cytometry was used to assess cell death type and cell cycle and the main morphological features of cell death were evaluated by May-Grünwald Giemsa stain. Clonogenic assays enabled assessment to differences in reproductive viability (capacity of cells to produce progeny) [5–11].

Results

Our results showed that IR induces cytotoxic and antiproliferative effects in OE19 and HT1376 cells in a dose-dependent manner and dose and time-dependent manner, respectively. Main types of cell death observed were apoptosis or necrosis. We also observed cell cycle arrest on G2/M phase and a decrease of the Ki-67 expression in both cell lines studied. The cell survival curves were established according to the quadratic linear model for both cell lines. For OE19 cell line the DL50 was 2.47 Gy and for HT1376 cell line was 3.10 Gy, accompanied by a decrease in the survival factor for both lines.

Conclusions

The direct effects of the DNA molecule that are unrepairable, activate multiple intracellular mechanisms on radio-sensitivity, such as cell death, namely by apoptosis and necrosis and cell cycle arresting G2/M phase. The increase radiation dose induces alterations in cell death, from apoptosis to necrosis. According to our results, OE19 is more radio-sensible than HT1376 cell line. This study demonstrates that molecular mechanisms underlying RT are important in oesophageal adenocarcinoma and bladder cancer therapeutic approaches.

Acknowledgements

The authors would like to thank to Institute for Biomedical Imaging and Life Sciences is a research Institution of the Faculty of Medicine, University of Coimbra and to Radiotherapy Service of the Centro Hospitalar e Universitário de Coimbra.

Rita MF Leal1, Amâncio AS Carvalho2, Marília S Rua1

Correspondence: Rita MF Leal (ritamariaferreiraleal@gmail.com)

Background

Sociodemographic characteristics have been related to breastfeeding (BF) duration. Research has shown interest in these factors which may even be predictive [1].

Objective

To analyse a correlation between sociodemographic characteristics (maternal age, level of education, marital status, number of older children, child gender, child’s year of birth) and breastfeeding (BF) duration.

Methods

An observational, descriptive-correlational and cross-sectional study was conducted. The population comprised mothers who had a biological child in 2012 and 2013 in the Centre region of Portugal. A non-probabilistic sample (n = 427) was collected using an online questionnaire with snowball effect. Data was analysed using SPSS software.

Results

Maternal age, marital status, child’s gender and child’s year of birth did not present a statistically significant relationship with BF duration. On the other hand, mothers educational level (p = 0.001) and the number of older children (p = 0.018) presented a statistically significant relationship with BF duration.

Conclusions

Our study did not establish a correlation between maternal age and BF duration which contradicts other findings [1–3] and can be explained by pregnancy and childbirth postponement nationwide [4]. In relation to mothers’ educational level, we verified a statistically significant relationship with BF duration, being that the mothers who detained a higher level of education, breastfed longer [1,5–7]. As for marital status, we did not verify a statistically significant relationship with BF duration, which is in line with a recent Portuguese study [5] but differs from other international studies [2,3] that refer that married mothers breastfeed longer. This difference can be explained by cultural differences and by the paradigmatic change of the women’s role, concept of marriage, and a diversity of forms of family life (great increase in unmarried couples). We also verified an increasing tendency in BF duration with the increase of the number of older children [6,7], but it was not lowest in primiparous women which contradicts other findings [6,7]. This may be clarified, once again, by the sociodemographic changes in the last decade in Portugal that include population ageing, an increasing tendency for families with an only child [4] and the great investment in parenthood and child well-being. Health care professionals should consider that sociodemographic characteristics are in constant change and so is its relation to health. These findings help health professionals to identify who may be most vulnerable to early weaning and allows them to explore expectations and develop a care plan accordingly.

References

1. Scott J a, Binns CW. Factors associated with the initiation and duration of breastfeeding: a review of the literature. Breastfeed Rev. 1999;7(1):5–16.

2. Callen J, Pinelli J. Incidence and duration of breastfeeding for term infants in Canada, United States, Europe, and Australia: a literature review. Birth. 2004;31(4):285–92.

O84 Population analysis of cleft lip and/or palate patients treated in the Postgraduate Orthodontic Department of the Faculty of Medicine of the University of Coimbra

Ana Roseiro, Inês Francisco, Luisa Malo, Francisco Vale

Universidade de Coimbra, 3004-531 Coimbra, Portugal

Correspondence: Ana Roseiro (a-roseiro@hotmail.com)

Background

Cleft lip and palate is one of the most common dentofacial congenital anomalies, affecting on average 1:700 new-borns. Although the aetiology of this condition is not fully understood, it seems to be related with both genetic and environmental factors. This type of malformation may occur isolated or it could be associated with a syndrome. When compared with the general population, cleft lip and palate patients present in a larger number, a series of dental anomalies in number, size and tooth shape.

Objective

Analyse in a population of cleft lip and/or palate patients a number of anatomical and sociodemographic characteristics.

Methods

The study included 60 patients referred to the Postgraduate Orthodontic Department of the Faculty of Medicine of Coimbra by the Children’s Hospital during the year of 2015. All data related to patients was obtained through a meticulous and thorough orthodontic exam (medical history, cast models, intra and extra oral pictures and radiographic exams).

Results

Of the 60 patients included in the study, 65% were of male gender. Patients with 11 years of age were the most prevalent ones (5-22 years of range). The most common anomaly was unilateral lip and palate cleft (63%). Maxillary endognathy was present in 75% of the cases. 74% of the patients presented at least one dental agenesis being the upper lateral incisor the more common one.

Conclusions

Cleft lip and palate is more frequent in male individuals and seems to be associated with conditions like maxillary endognathy and dental agenesis, with orthodontic treatment being required in these patients.

Keywords

Cleft lip and palate, Dental agenesis, Maxillary endognathy.

O85 Drug use in pregnant women of Mirandela, Macedo de Cavaleiros and Bragança

Correspondence: Olívia R Pereira (oliviapereira@ipb.pt)

Background

The use of drugs during the gestational period is a subject of great concern, once the exposure of medicines may result in toxicities with possible irreversible lesions for the foetus. In fact, drugs in pregnancy have been restricted since the accident of thalidomide. In 1979 the U.S. Food and Drug Administration (FDA) adopted the classification of drugs as the risk associated with their use during pregnancy, these being classified into 5 classes (A, B, C, D and X).

Objective

The aim of the present study was to characterize the use of drug therapy in pregnant women of Mirandela, Macedo de Cavaleiros and Bragança regions.

Methods

A cross-sectional study was performed through application of a questionnaire to 134 pregnant women in the Northeast (Mirandela, Macedo de Cavaleiros and Bragança regions) during consultation in a health centre. Descriptive statistics were used, as well as univariate and multivariate statistical analysis, with a significance level of 5%.

Results

The sample comprised a total of 134 pregnant women from the Northeast area, mostly with ages between 21 and 30 years or between 31 and 40 years (56.7% and 35.8%, respectively), holding secondary or higher education (48.5% and 42.5%, respectively) and employment (67.2%). About half of the pregnant (47.8%) were in the 3rd quarter of pregnancy. 78.4% (105 women) of the pregnant had used drugs during the pregnancy, 64.4% after medical prescription, and 71.6% have acquired the medication at the pharmacy. In detail, the medication most used was folic acid (64.2%, 86 of the pregnant women) which belongs to class A; paracetamol from class B (35.1%, n = 47), iodine (17.2%, n = 23) and iron (14.9%, n=20), both belonging to the class A. Less reported drugs have included metoclopramide (6.0%) and Vitamin D3 (6.0%), from Class C and Class D, respectively. It is important to refer that 12.7% of the women had a chronic disease and 2.2% had an acute disease during pregnancy. Diseases more reported were asthma and diabetes.

Conclusions

In the present study, the use of drugs in pregnancy was independent of the education level, chronic or acute disease, locality, marital status, employment status, gestational period and health centre. The drugs most used by pregnant women belong to class A (18.5%), class B (25.9%) and class C (33.3%) and the less used belong to class D and X. Supplements such as folic acid, iodine and iron and the analgesic paracetamol were the most reported.

Inês Cruz, Fernanda Bastos, Filipe Pereira

Nursing School of Porto, 4200-072 Porto, Portugal

Correspondence: Inês Cruz (inescruz@esenf.pt)

Background

The use of a standardized language in nursing supports the nursing science and contributes to the management of the discipline's own knowledge [1, 2]. Nurses can control, practice, and teach only what they can name. The documentation of care in Nursing Information Systems in Portugal is based on the international classification for nursing practice (ICNP®) [3].

Objective

The purpose of this study is to describe and specify nursing diagnoses centred on the clients’ knowledge for self-managing the medication regime in chronic diseases.

Methods

Exploratory study. All nursing documentation, concerning all health centres and public hospitals, customized in the Portuguese nursing information System-SAPE® (2012) and in SClinico® (2016) was subject to content analysis. Content analysis of nursing documentation was based on ICNP® terminology. After conducting content analysis, the material was validated by a group of 14 nursing experts.

Results

A set of nursing diagnoses related to the person's knowledge on the medication regime management were specified. Knowledge refers to the development of the client's informational content about how to manage his medication regime. These diagnoses focus on the potential to improve knowledge about: self-management of the medication regime; medication regime; response to medication and side effects of medication; health services; complications and preventing complications of compromised self-management; and the use of devices to facilitate drug intake.

Conclusions

The specified diagnoses reflect nursing care needs that nurses document in the Portuguese nursing information systems, related to medication self-management. These results are contributes to the formalization of nursing science’s knowledge in the field of self-care of people living with chronic diseases.

Correspondence: Teresa Guimarães (tguimaraes@estesl.ipl.pt)

Background

Hypertension constitutes the most prevalent modifiable cardiovascular risk factor and a major risk factor for cognitive decline and dementia. Antihypertensive medication is essential to minimize the consequences of the disease, stressing the need for a high adherence to treatment to achieve hypertension control. Illness perceptions and beliefs about medication have been identified as important determinants of treatment adherence.

Objective

To identify patients’ perceptions on hypertension and beliefs about antihypertensive medication and assess associations between these beliefs and medication adherence.

Our findings suggest that illness perceptions play a key role in the way patients cope with their illness, through the development of patient’s beliefs concerning the necessity of medication and concerns about taking it, and also by directly influencing adherence to treatment. In our study, non-adherence is essentially unintentional (patients forget or are careless about treatment), what explains the lack of association between adherence and beliefs about medication, although we have found that, for the majority of subjects, concerns about taking medicines are outweighed by a belief in the necessity of the prescribed medication.

Correspondence: Marco Batista (marco.batista@ipcb.pt)

Background

The self-determination theory suggests that humans have several basic psychological needs that are innate, universal and essential to health and well-being, namely, autonomy, competence and relation perception. The wellness construct, measured by satisfaction with life is understood as a judgment process in which individuals generally estimate the quality of their lives based on their own criteria.

Objective

This study has as main objective to identify the motivations, basic psychological needs and satisfaction with the life of the Portuguese elderly for the practice of supervised Physical Activity; and to analyse the relations and comparisons between levels of practice, sex and institutional context.

Methods

A cross-sectional study was carried out with 62 elderly volunteers of both sexes (15 males and 47 females), institutionalized and non-institutionalized, belonging to the Municipality of Castelo Branco, with a mean age of 79.61 ± 9.34 years. The instruments used were the Behavioural Regulation in Exercise Questionnaire, the Basic Psychological Needs Scale Exercise and the Satisfaction with Life Scale.

Results

The results show that, apparently, the motivation that maintains the constant practice of physical activity supervised by the elderly focuses on the autonomous motivation. It can also be observed that, except for the amotivation, where women have higher levels of amotivation for the practice of supervised physical activity than men, that is, they may be more exposed to an absence of motivational orientation, there are no differences at the level of the remaining motivational variables, as well as the basic psychological needs and life satisfaction between the male and the female. The results showed that, in the supervised elderly, the satisfaction of the basic psychological needs leads to autonomously motivated behaviours, promoting high levels of satisfaction with life.

Conclusions

We can conclude that autonomous motivation and the satisfaction perception of basic psychological needs are externalized as factors of great importance, because they appear to be a catalyst for this population to remain active and, in a way, to “compromise” with This lifestyle.

Correspondence: Marco Batista (marco.batista@ipcb.pt)

Background

The Transcontextual Model suggests an original contribution to knowledge, and can illustrate human behaviour, interpreting the theory of self-determination, contrasting with the hierarchical model of motivation, as well as with the theory of planned behaviour, seeking to predict behaviours. The strength of this model lies in the integration of different motivational theories, such that an explanation is a predicted complement to the motivational processes that are inexplicable in theory by each component.

Objective

The present study was designed with the objective of testing an extension of the Transcontextual Model of motivation in predicting healthy lifestyles of active adults.

The structural equations model showed that the perception of social relation positively and significantly predicts autonomous motivation. In turn, this positively and significantly predicts control perception, predicting this, positively and significantly, the intentions. Eating habits and rest habits were positively and significantly predicted by intentions, and tobacco consumption was predicted negatively and significantly by intentions.

Conclusions

From the conclusions reached in this study, it is important to emphasize the importance of fostering social relations, since this will favour autonomous motivation, promoting a greater behavioural control over the intentions of the practitioners, thus generating more healthy eating habits, rest habits and lower consumption of tobacco.

Eunice Henriques, Maria FM Gaspar

Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal

Correspondence: Eunice Henriques (eunice.henriques@esel.pt)

Background

The increase of new diagnoses of HIV infection in young males, especially those who have sex with men, and the high percentage of late diagnoses, particularly in middle-aged heterosexuals continues to be our major concerns. As AIDS is now considered a chronic disease, its effective and sustainable treatment relies naturally on self-management of symptoms as well as promoting adherence to therapy. This will reduce costs and promote well-being in the person's life.

This is a quasi-experimental, study with pre and post intervention evaluation. Participants were selected at the HCC Day Hospital; HIV-infected, multi-stage, more than 18-year-old, to have ART for at least 6 months. We carried out the sociodemographic characterization and validation of the instruments. The intervention consisted in the application of a strategy manual for self-management of the most frequent symptoms.

Results

The 1st Study sample consisted of 374 individuals, 74.1% were males. The age varied from 20 years to 78. The average with 47.34 years. Of the 64 presented symptoms, the number of symptoms ranged from 0 to 53 by the same participant. The mean was 18.96 symptoms per person. The most frequent symptoms were: anxiety, fatigue, fear and worries and depression. Most do not use strategies, or they are not effective in managing these symptoms. Of the total number of respondents, 30% never stopped taking the medication and the same number failed to take the therapy in the last 3 months, the main reason is simple forgetting.

Conclusions

Most participants do not adequately manage the symptoms due to lack of knowledge of the appropriate strategies, indicating devaluation based on the belief of inevitability (pain). Most say they adhere to ART (70%), making more than 95% of the shots, which is not always consistent with viral load.

Correspondence: Virginia Fonseca (virginia.fonseca@estesl.ipl.pt)

Background

Aortic stenosis represents the third most common cause of cardiovascular disease, with indication for surgical valve replacement with a biological or mechanical prosthesis in most symptomatic patients. Biological prostheses present a higher risk of reoperation due to valvular degeneration; however, do not require prolonged therapy. In spite of the long durability, mechanics prosthesis need chronic anticoagulant therapy. The surgical intervention for valvular replacement is not free of complications and can be grouped into three main categories: prosthesis complications, non-prosthesis related cardiac complications and non-cardiac complications.

Objective

To characterize the cardiovascular complications resulting from the implantation of biological or mechanical aortic valve prosthesis, by surgical procedure.

Methods

32 patients were evaluated in four follow-up moments. Cardiovascular complications resulting from the implantation of a valve prosthesis (biological or mechanical) were analysed, and also the value of the pre and post-surgical mean gradient, symptoms and cardiovascular risk factors. All the variables under study were characterized by descriptive statistics, except the mean gradient variable, for which the Friedman test was used.

Results

The most frequent complication detected in individuals who implanted biological aortic prosthesis in the first (18.75%), second (21.88%), third (21.88%) and fourth (9.38%) follow-up moments were arrhythmias and electrical conduction disturbances. There is a higher prevalence of Atrioventricular Block and Left Bundle Branch Block, in the first and second follow up moments that reverts in the last two. The complication with higher prevalence in the sample of individuals with mechanical prosthesis at the first (9.38%) and second (3.13%) follow-up moments were arrhythmias. At the third and fourth follow-up moments, the main complication was paravalvular leaks (9.38%). Statistically significant differences were detected in the mean gradient throughout the follow-up (χF2(4) = 12.122, p = 0.016).

Conclusions

The most frequent complications in individuals with aortic prosthesis were arrhythmias and paravalvular leaks. The structural deterioration of the biological valve prosthesis is the most commonly described complication, which may result in insufficiency of the valvular prosthesis and paravalvular leaks. However, electrical conduction disturbances after aortic valve replacement may occur through tissue manipulation of the conduction system. These disorders may be transient; however, certain patients require pacemaker implantation in the post-surgical period.

O92 A Safe staff nursing model: relationship between structure, process and result variables

Maria J Freitas1, Pedro Parreira2

Correspondence: Maria J Freitas (mjbsfreitas@gmail.com)

Background

The need to adequate nursing resources to the real needs of patients, while maintaining a balance between the quantity and the skills, without neglecting the quality and safety, has been a concern for managers. The absence of a consensual methodology to support the operationalization of a safe staff nursing, was the starting point of this investigation.

Objective

Develop an explanation Model Safe Staff Nursing (SSN) and analyse the relationships between the Structure, Process and Results.

Methods

Cross-sectional and correlational study. Data collection was achieved through a three-sample questionnaire: nurses (629), chief-nurses (43) and patients (1,290), from 43 units of 8 Portuguese hospitals. A patient’s form was applied to assess the satisfaction with nursing care. The data collection instrument for nurses and chief- nurses consisted of three parts: the first characterizing the personal and professional variables, the second featuring the healthcare organization and the service on which the respondent work, and the third part was to obtain information about: overall satisfaction at work (Evaluation Scale of Overall Satisfaction at Work [1]), intended to abandon the Work (Intent Abandonment of Employment Scale [2]), quality nursing care and risk/occurrence of adverse events (Adverse Events Associated with Nursing Practices Scale [3]). The psychometric assessment study of the measuring instruments, performed by Factorial Exploratory Analysis and Confirmatory demonstrated adequate validity and reliability. For model validation, we used the technique Structural Equation Modelling.

Results

The relational structure of the model is statistically significant (χ2(421) = 2209.095; p = 0.000; χ2/gl = 5.247; GFI = 0.833; CFI =0.815; RMSEA = 0.082), being adequate to explain the impact of Structure variables over Results of SSN, and the Process variables over Results. The “Availability of nurses with the right mix of skills”, “Availability of nurses in adequate amount” and “Safe environment” (Structure-variables) explain 2% of the variable variance of “Provision of quality nursing care” (Process-variables), 15% of the variance “Patient satisfaction”, 94% of the variance “Risk and occurrence of adverse events on patients” (Results-Patients), 25% of the variance “Results-Nurses” and 100% of variance “Results-Organization”.

Conclusions

The Safe Staff Nursing Model clearly identifies the influence of SSN on the results obtained for patients, nurses and organizations. Warns are given for the need to give more attention to issues of SSN, in particular to the constitution of balanced teams, based on a mix that includes number and competencies of nurses, versus workload/patients nursing care needs, as a strategy for maximizing resources and promoting the sustainability of organizations.

Correspondence: Geoffrey Mitchell (geoffrey.mitchell@ipleiria.pt)

Direct Digital Manufacturing is an emerging set of technologies, which are able to produce complex objects without the need for molds or specific tooling. The preparation of food for human consumption is a centuries old craft, which results in food with high sugar and salt levels leading to a poor health for many people and not contributing to the recovery of seriously ill-hospitalized patients. One of the key challenges is to tailor food to the individual to match their dietary requirement and metabolic characteristics. We believe that direct digital manufacturing is able to address these issues. To date the use of 3D printing for food has been restricted to the production of aesthetic shapes for chocolate and pasta products. We see the potential in a different way in which we can tailor the food to the individual incorporating where required drug-based therapies whilst retaining the requirements to be visually pleasing. In addition, it will be possible to guarantee all the organoleptic characteristics to which the consumer in general is familiar (such as smell, sound and texture). The mouth is the gateway for food and its acceptance requires specific taste triggers. We consider that by exploiting Direct Digital Manufacturing it will possible to optimize such taste triggers whilst retaining the nutritional balance and potential. Every consumer (in general) has challenges in chewing and swallowing and engineered food has the capability to achieve this, especially when coupled with a model of the processes of the mouth and the oesophagus, parameterized to the individual. Once the food reaches the digestive system, all of the foregoing topics are largely irrelevant, other than to consider where the nutritional or therapeutic agents are extracted. The challenge of the oral intake of insulin is the best-known situation, but the delivery of chemotherapeutics is another area of challenges. It is necessary to shield the toxic therapeutic from the taste sensors and the digestive system so that it reaches the critical area of the digestive system intact. We are developing a comprehensive food design and manufacturing system that will allow each of these challenges to be met. We expect the first use of such system will be to expedite the recovery of seriously ill patients in hospitals. As enhanced testing procedures become more widely available through technological developments a wider use in the home is expected.

Keywords

Engineered Food, Nutritional, Therapeutic.

O94 The influence of an eight month multicomponent training program in edlerlies gait and bone mineral mass

Correspondence: Filipe Rodrigues (ptfiliperodrigues@gmail.com)

Background

Aging induces neuromuscular changes and mass, strength, muscular resistance and power, motor coordination, so, reaction and movement speed reduction may be compromised [1]. These changes result in slower movements and functional limitations in gait and weight transfer activities [1]. Even more, the functional fitness decreasing due to aging, increases the risk of falls and bone fractures [2], reducing the elderly’s quality of life.

Objective

Thus, the aim of this study was to assess the influence of an eight months multicomponent training program in elderly’s gait and bone mineral mass (BMM).

Methods

Forty-nine elderlies were recruited for this research with 64.39 (± 6.33) years old, 11 males with 67.45 (± 4.93) and 38 females with 63.50 (± 7.47) years old. The subjects were community living persons of Bragança. All procedures carried out in this research were in accordance to the Declaration of Helsinki. The multicomponent training program followed the Carvalho et al. [1], recommendations. Each session time volume was between 50 to 60 minutes. The sessions were divided in five parts: 1) general warm-up; 2) walking with aerobic exercises; 3) 1 to 3 sets of exercises of muscular resistance with 12 to 15 repetitions; 4) Static and dynamic balance training; 5) An active recovery period with stretching and breading exercises. The elderlies gait was evaluated with Berg Balance Scale (BBS) and BMM with bioimpedance (Tanita, BC-545). The Wilcoxon-Mann-Whitney test allowed to assess the differences between pre and post 8 months of the training program in BBS and BMM. The tests were performed with a significant level of 5%.

Results

The BBS values pre and post the multicomponent training program for BBS were 47.33 and 50.33 respectively. In BMM, the pre and post values were 2.36kg and 2.39 kg. Despite the differences in BMM means, they were not significant between the two moments (F = 1.253; p = 0.706). However, the same did not occur in terms of BMS values (F = 1.967; p< 0.001), where gait values increased significantly in the second moment.

Conclusions

Although the multicomponent training program did not increase the BMM in the elderly subjects, gait values increased significantly. Thus, it is possible to conclude that, the training program significantly improved the elderlies’ gait and quality of life.

Correspondence: Sónia Ramalho (sonia.ramalho@ipleiria.pt)

Background

Virginity can be defined as the attribute of a person who has never been subjected to any type of sexual intercourse. To be aware of the sexual behaviour and virginity of young people is fundamental that nurses construct health education intervention programs in this specific area.

Objective

To know the perception of Portuguese and Cape Verdean university students about virginity.

Methods

A descriptive, cross-sectional study using a questionnaire consisting of sociodemographic data and the perception scale on the loss of the virginity by Gouveia, Leal, Maroco and Cardoso (2010) [1]. A sample composed by 108 young people from the Republic of Cape Verde and 141 young Portuguese participated in the study. All formal and ethical procedures were taken into account.

Results

Young Portuguese university students presented a mean age of 20 years and 73% of the young people reported having started their sexual life at 17.00 years old, on average. The majority of the young people (66.7%) started their sexual activity with their boyfriends, using protection/contraception (70.9%). Young college students from Cape Verde had a mean age of 21.26 years, 69.4% reported having started their sexual life, on average, at 17.37 years. The majority (63.0%) started their sexual activity with their boyfriend, using protection/contraception (62.0%). Portuguese young people showed high levels of agreement with the ideal associated with the genital vision of loss of virginity (Md = 18.95, Xmax = 25.00, Xmin = 11.00), while Cape Verdean students had lower levels of agreement (Md = 12.34, Xmax = 24.00, Xmin = 5.00), showing in 41.7% of the cases, disagreement that 'a lesbian woman, who has never had sex with a man, is virgin and a 38.0% disagreement with the statement that “men who only practice oral sex, or anal sex or other forms of sex, do not lose their virginity”.

Conclusions

The study shows that there is still considerable lack of knowledge in young people about the conceptualization of virginity and a very genitalized view of it in the Portuguese young people, in lower agreement with the perception of young Cape Verdeans.

Correspondence: Margarida Ferreira (margasufer@gmail.com)

Objective

To determinate the effectiveness of a specific exercise program on balance and functional capacity of the daily activities of institutionalized elderly.

Methods

A randomized controlled trial. A total of 21 elderly were selected from the Santa Casa da Misericórdia de Santo Tirso and randomly distributed into experimental (n = 11) and control groups (n=10). The experimental group performed a specific program of exercises (resistance training, balance, coordination and flexibility) during 4 weeks, while the control group wasn’t subjected to any intervention. The primary outcome was balance, as measured with a Performance Oriented Mobility Assessment scale (POMA), and the secondary outcome measure included functional capacity by the Timed Up & Go test. Evaluations were carried out at the beginning and end of the exercise program, for both groups. The data were analysed with Statistical Package for Social Sciences, version 22.0, for all test procedures, a probability of p< 0.05 was considered to be statistically significant. Statistical analyses of POMA and TUG were performed with use of independent and paired t-test. POMA and TUG score association were analysed via the Pearson correlation, after the intervention.

Results

In the pre-intervention, groups were homogeneous (p < 0.05). After intervention, there were no statistically significant differences between groups in terms of the total balance and dynamic balance subscale, except static balance subscale (p < 0.048). In the functional capacity test, the experimental group reduced significantly the functional activity time into intragroup (p < 0.001), however there were no significant differences between groups (p < 0.633). After intervention, the experimental group had a significantly strong negative association (p = 0.001).

Conclusions

The results of this study demonstrated that this specific exercise program was not effective in terms of the total balance and functional ability of institutionalized elderly.

Correspondence: Luís Sousa (luismmsousa@gmail.com)

Background

Pain is the most common symptom in patient’s undergoing haemodialysis, due to comorbidity, although it is frequently underdiagnosed [1-2]. Pain in these patients is not valued in its entirety and does not consider the limitations resulting in their quality of life [3]. The Brief Pain Inventory short form (SF-BPI) is the most widely used instrument and has the most number of foreign language translations [4].

Objective

To evaluate the prevalence of chronic pain, and intradialytic pain in patient undergoing haemodialysis, as well as the effectiveness of analgesic therapy.

Methods

Cross-sectional, descriptive and observational study. A random sample consisting of 172 patients undergoing haemodialysis in two clinics in the region of Lisbon, Portugal. The Brief Pain Inventory, which analyses the influence of pain in a patient’s life, was only applied to evaluate chronic pain [5]. The Visual Analogue Scale was used to assess the intradialytic pain. Tests were administered during dialysis sessions from May to June 2015. Categorical variables were expressed as percentages and continuous variables were expressed as mean standard deviations or medians. This study was approved by the Ethics Committee of Diaverum (N 1/2015).

Results

The sample consisted mostly of men (61.6%) of Portuguese nationality (80.7%), the mean age was 60 years (± 14.4), and patients were under haemodialysis treatment for 72.6 months (± 54.4). Chronic pain occurs in 54.1% of patients and intradialytic pain in 75%. The causes of pain were musculoskeletal (69.3%), associated to vascular access (19.3%) and other causes (11.4%). Chronic pain was most commonly located in the legs (43.2%), followed by back (21.6%) and vascular access (19.3), head (8%), arms (4.5%), abdomen (2.3%) and, lastly, chest (1.1%). The percentage of patients that took analgesics for chronic pain was much higher (62.0%), of these 87.8% are non-opiates, 10.2% weak opiates and 2% strong opiates. The other therapeutic interventions referred were: rest (24.1%), massage and relaxation (6.3%), cryotherapy (1.3%), exercise (1.3%), while 5.1% reported doing nothing. The effectiveness of the treatment was successful for chronic pain, in 62.6% of the patients, there was a relief felt of over 50%.

Conclusions

Pain of musculoskeletal origin is a frequent symptom in our sample. The pharmacological management of chronic pain is the most applied intervention.

Correspondence: Cristiana Firmino (furtado.cristy@gmail.com)

Background

Musculoskeletal symptoms are the most common conditions in society, being indicated as one of the main factors of disability during the life cycle of an individual [1-2]. Students are exposed to the factors that can trigger these musculoskeletal symptoms [3], both during class periods and clinical teaching. Prevalence of musculoskeletal pain is higher in the cervical region among nursing students of 1st year and 2nd year, and lower back in nursing students of the 3rd and 4th years [4].

Objective

To determine the prevalence of musculoskeletal symptoms in nursing students.

Methods

Cross-sectional and descriptive study. One hundred and fifty-five (155) nursing students from two nursing schools in Lisbon participated in this study. The data collection instrument consisted on sociodemographic and health behaviour variables and the Nordic musculoskeletal questionnaire (NMQ). The NMQ consists of 27 binary choice questions (yes or no) [5]. The variables were expressed as percentages. This study was approved by the Ethics Committee of two nursing’s schools.

Results

83.23% of the sample are females, single (88.38%) and 32.26% are working students. 81.94% are non-smoking; 87.1% do not usually ingest alcoholic drinks; 65.81% use a backpack and 23.23% carry objects on their way to school. 49.03% spend between 2 and 4 hours on the computer and electronic devices and 42.58% spend more than 4 hours. 71% spend more than 4 hours seated during classes. 85.8% had no training prevention of musculoskeletal injuries. The prevalence of musculoskeletal symptoms by location of the aches, pain, discomfort and numbness were as following: 66.23% in the neck; 52.29% shoulders; 7.24% elbows; 39.47% wrists/hands; 20.53% upper back; 69.33% lower back; 15.33% hips/thighs, 32% knees and 22.82% ankles/feet.

Conclusions

The most frequent aches, pain, discomfort, numbness location are located on the neck, shoulders and lower back. The main causes related to musculoskeletal injuries are the transportation of weights, use of computer and electronic devices and to be seated for long periods of time. It is recommended the implementation of prevention strategies in order to reduce the occurrence of musculoskeletal injuries.

Susana Cardoso1, Carla Nunes1, Osvaldo Santos2, Isabel Loureiro1

Correspondence: Susana Cardoso (suscardoso@yahoo.com.br)

Background

Proper eating habits are crucial to a healthy life. It is important to understand the determinants of eating choices made at adolescence because this stage of life is paramount for the formation of lifelong enduring habits.

Objective

To identify determinants of eating choices based on adolescents' perception and characterizing them, in particular, to the level of relevance attributed by adolescents.

Methods

A cross-sectional study was carried out, based on a sample of 358 adolescents (14-18 years old) from two schools of Coimbra. First, a quantitative study was carried out using the scales: EHA (eating habits scale), TAA-25 (eating attitudes test) and GSQ (general self-efficacy scale). In a second step, a qualitative study was carried out with subgroups that were selected from the results of the first phase of the study. These subgroups presented opposite patterns of habits (group A: better eating habits - EHA≥160 and group B: worst habits - EHA≤125) and we moved into a grounded theory approach with semi-structured individual interviews.

Results

Gender emerges as a determinant of eating choices pattern, with girls assuming more adequate eating habits (t =3.84; p <. 0001; r2adjusted= .037, p< .0001). The perception of general self-efficacy assumes greater relevance for boys, functioning as a protective factor that reduces unhealthy options. Through multinomial regression models, we could see that gender and general self-efficacy have a big influence on eating habits. The ideals of beauty have influence on this effect. Resisting adversity has an important influence in the choices, being associated to self-regulation. The situations of risk to develop an eating behaviour disturbance appear mainly in the cases of adolescents presenting better habits (rSP= .203; p < .001) and are more frequent in girls (t = 3.54; p < .0001; OR = 4.04). Through content analysis it was possible to identify determinant factors that were perceived by adolescents in both groups. The ones that were more often mentioned (in a decreasing order) were family influence, taste preferences, knowledge of healthy eating rules and availability. This was followed by determinants such as self-control capacity, feeling well or bad, peer influence, feeling hungry or full, developing a task or not, impulsiveness, time available and humour/stress.

Conclusions

The differences found between sexes can justify differentiated interventions. Our results also suggest the relevance to work on self-image. Family must be considered as an integrating part of the interventions in health education. Political measures taken by schools and government agents can also have a very important role in making healthy choices easier.

Correspondence: Samuel Honório (samuelhonorio@hotmail.com)

Background

Sports practice develops several motor skills that help practitioners not only in game, but also brings benefits to their physical fitness. Practitioners develop an effective motor response and quick solutions to daily situations.

Objective

Determine if the regular practice of sports influences or not motor skills, physical fitness and body composition of students. We wish also to identify the correlation between the performance of students in specific motor skills tests of football, physical fitness and body composition.

Methods

The sample consisted in 160 (divided in two groups of 80) male students, 12-year-old, living in Madeira and that practice football regularly. One group of students had an extracurricular physical activity beyond curricular physical activity (Federated Sports), and the other group entails students who only practice physical activities as a curricular activity (School Sport). Body composition (BMI and %BF) were also evaluated by Fitnessgram. To evaluate motor abilities the software Predictive Analytics Software – PASW was applied.

Results

After analysing the results, we became aware that students with extracurricular physical activities had better results in motor skills than students with curricular physical activities. This result is perhaps the less surprising in the set of all assessments due to the longer physical commitment of these students in relation to the students that only exercise in the context of curricular activities. Regarding physical fitness, students with extracurricular physical activity can have more students in HFZ (healthy fitness zone) than students with curricular physical activity. Regarding the arms extension and flexion, 26% of the students with curricular physical activity are above HFZ, achieving better performance than the students that have extracurricular physical activity. According to the skills measured, the students with extracurricular physical activities achieve a relatively higher average than students with curricular physical activities. Regarding body composition and after determining the BMI and %BF of each group, it appears that students with extracurricular physical activities achieve better results than those achieved by the students of curricular physical activities.

Conclusions

The regular practice of sports with curricular and extracurricular physical activities, seems to contribute to an improvement of physical fitness, motor skills and body composition of students, keeping them in a healthy fitness zone, thus preventing premature cardiovascular diseases, among others.

O101 Promotion of language skills in children aged 5-6 years, without language disorders

Tiago Rodrigues, Catarina Mangas

School of Education and Social Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

Correspondence: Tiago Rodrigues (tiagoac.rodrigues@gmail.com)

Background

Language is a human faculty that enables communication with various interlocutors. This appears early and develops, exponentially, in the early years of life. For such, it is important that the surrounding environment is stimulating and allows the exchange of experiences with other speakers. The pre-school age is a milestone in the development, not only for stimulation, but also to identify deviant behaviours. In order to avoid future complications, professionals who deal with these children should prevent any language disorders. The speech and language therapist, being a health professional trained to deal with the areas of communication and language, has a prominent role in this preventive action. In Portugal, there aren't many references concerning prevention in language disorders. As such, it is necessary to promote a definite change in the present scenario, namely with innovative and stimulating materials to develop language.

Objective

Therefore, this is an exploratory-descriptive study, with a qualitative-quantitative paradigm and the general objective of this study was “to create and implement a Language Skills Promotion Program for 5-6 year-old children without any language disorders, in order to analyse their potential influence on their language skills”.

Methods

To this end, a 10-session program was build, evaluated and validated by a panel of experts. Before the beginning of the program, all the sample children were evaluated with a language test for preschool age. A sample of 12 children, divided equally in two groups, was selected and the program was applied by a Speech and Language Therapist only to one of these groups. At the same time, the Childhood Educator’s opinion was collected in order to understand the influence of the respective program on the children's language skills.

Results

The final results of the study show that children who participated in the program improved their language skills, which was not the case of the children who did not take part in that same study. These results prove that the investment in prevention actions, through the promotion of language skills, enhances the oral and written language skills of children, especially in terms of literacy, something that is indispensable for their educational success.

Conclusions

Finally, the study also emphasizes the importance of primary prevention actions, such as the application and development of programs to stimulate or organize information actions, with a view to promoting the health and the well-being of society in general.

O102 The impact of a training program on the performance of nurses working at a chemotherapy ward

Joana M Silva, Isabel M Moreira, Anabela Salgueiro-Oliveira

Nursing School of Coimbra, 3046-851 Coimbra, Portugal

Correspondence: Joana M Silva (joanamota19@gmail.com)

Background

Oral mucositis (OM) is the major complication reported by patients undergoing chemotherapy and/or radiotherapy, with a strong impact on their quality of life by compromising physical and psychological functions [1]. OM affects 40-76% of patients undergoing chemotherapy and up to 90% of patients undergoing radiotherapy [3,4]. Inadequate oral hygiene is a patient-related risk factor in which health professionals can intervene [5,7], namely nurses [6]. Oral examination allows diagnosing the different stages of OM and establishing an individualized care plan.

Objective

To assess the impact of a training program on the performance of nurses working at a chemotherapy ward regarding OM risk assessment and prevention in cancer patients.

Methods

This action-research study aimed to identify nurses' interventions in patients with or at risk for OM. Data were collected from the nursing records of 110 patients between October and November 2016 in order to analyse the nursing documentation pattern based on an evidence-based grid. Data were analysed using descriptive statistics. The discussion with the team nurses about the results obtained in the document analysis was used to design a three-session training program. The next step was to reanalyse the nursing documentation pattern with the purpose of identifying positive changes in the aspects under study. The study was approved by the Ethics Committee.

Results

The analysis of the documentation pattern showed that 31.8% of the patients were not asked about oral hygiene practices, although 25.7% of the sampled patients were in the 1st cycle of chemotherapy. A total of 21.9% of patients were not observed during oral hygiene care. Only 14.5% of patients were given instructions about the treatment of side effects, and only 12.5% of them were given instructions about oral hygiene care. Only 2.7% of the patients had their oral cavity/mucous membranes examined, and all of them were diagnosed with OM. The implementation of the training program led to the introduction of standardized records for oral cavity surveillance. Nurses showed high adherence levels to this practice and considered it very relevant in clinical practice.

Conclusions

The research results show that nurses do not perform a systematic diagnostic evaluation of patients’ oral cavity and that few patients receive instruction on oral hygiene care, which does not contribute to patient empowerment in this area. The implementation of the training program showed that nurses recognize the need for and are committed to changing practices in this area.

O103 Styles of conflict management and patient safety

Anabela Almeida1, Sara Cabanas2, Miguel C Branco1

Correspondence: Anabela Almeida (aalmeida@ubi.pt)

Background

Health is a demanding scenario of changes and successive adaptations that, very easily, allows the emergence of differences between the involved and conflicts between professionals. Ineffectively managed conflicts in health organizations reduce quality, compromise safety, and increase the costs of health care delivery, secondarily to the goals of being effective and efficient.

Objective

Thus, the general objective of the study is to investigate the relationship between the conflict management styles used and the level of patient safety climate among the clinical services professionals at Hospital Pêro da Covilhã of CHCB.

Methods

The research is of a quantitative nature, of a descriptive and correlational character and of a transverse nature. The sample is non-probabilistic, consisting of 137 health professionals who work at CHCB. The use of ROCI-II and SAQ allowed the evaluation of the styles of conflict management and the perceptions of attitudes of health professionals related to patient safety.

Results

The results show that professionals, in all relations with the opponent, opt preferentially for collaboration, with competition being the least common style of conflict management. There were no differences in the styles of conflict management used in relation to the opponent. The participants presented positive attitudes towards the patient's safety, and it was verified that the professionals perceived a lower security relative to the dimension of management's perception and greater in relation to the dimensions of job satisfaction and recognition of stress, which show the highest values. The relationship between conflict management styles and the security climate level was verified. There is an association between literacy and conflict management styles, and years of service and conflict management styles. Regarding the ordinal independent variables, all are associated with the perceptions of the security climate.

Conclusions

Gender, marital status, integration period, function and years of service, influence the conflict management styles used; and age, gender, choice of service, integration period, function, area of service and years of service, influence the perceptions of professionals' attitudes related to patient safety.

Keywords

Conflict, Conflict management, Patient safety, Safety climate.

O104 Influence of a rehabilitation nursing care program on quality of life of the patients undergoing cardiac surgery

José Moreira, Jorge Bravo

Department of Sports and Health, School of Science and Technology, University of Évora, 7000 Évora, Portugal

Correspondence: José Moreira (jafonsomoreira@gmail.com)

Background

Cardiac rehabilitation (CR) is fundamental in the treatment of patients undergoing cardiac surgery (CS) regarding the educational, physical exercise and quality of life dimensions. Considering the competences of Specialist Nurses in Rehabilitation Nursing (SNRN) and the current prevalence of risk factors associated with cardiovascular disease, it is essential to implement programs in this area.

Objective

To assess the impact of SNRN interventions on a CR program during hospitalization (phase I) and 1 month after CS (phase II).

Methods

Participants (n = 11) submitted to CS, of both sexes, between 25 and 64 years of age (61.09 ± 7.09 years), that according to the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation, met the criteria for low or moderate risk, class B for participation and exercise supervision, absence of signs/symptoms after CS, with a left ventricular ejection fraction greater than 40%. Supervised interventions were performed during hospitalization, pre- and post-cardiac surgery, and 1 month after hospital discharge. In phase II, a physical exercise program was fulfilled according to the norms of the American College of Sports Medicine, comprising 3 sessions of physical exercise per week lasting between 30 to 60 minutes, including heating, aerobic exercise and recovery/stretching. Hemodynamic data (blood pressure, heart rate, peripheral oxygen saturation, pain) and the Borg scale were recorded in the initial, intermediate and final periods of each session. The aerobic capacity was evaluated through the 6-minute Walk Test and the health-related quality of life using the Short Form Health Survey 36 (SF-36V2) questionnaire.

Results

Significant statistical improvements were observed in the time/walk relationship, such as the increase in the respective functional capacity (p = 0.05) and quality of life (in various domains). During the hospitalization, the subjective perception of the effort of session to session decreased in 81.82% of the participants. T-test for independent samples revealed that differences in resting heart rate (phase I) were not significant, however, the difference in distances was significant at a 95% confidence level.

Conclusions

Nursing rehabilitation care is essential to improve the quality of life of patients undergoing CS in a phase I and II rehabilitation program. The benefits of CR programs are evident when initiated early after CC, reinforcing the need to increase their implementation in the rehabilitation of cardiovascular disease. Although the reduced sample size, the results represent a basis for future studies with a larger number of participants and a longer intervention period after CC.

Trial Registration

NCT03517605

Keywords

Cardiac Rehabilitation, Quality of Life, Rehabilitation Nursing.

O105 Study of knee arthroplasty in the elderly population with agricultural activity

Correspondence: Carla Costa (csofia_29@hotmail.com)

Background

Arthrosis is a major cause of pain, disability and loss of quality of life [1]. It affects the knee of elderly, overweight people and women frequently, and is influenced by articular overload, that occurs in Agriculture [2-9]. The majority of the individuals submitted to Total Knee Arthroplasty (TKA) refer significant decrease of knee pain and increase of knee functionality [1]. In this context, there are no studies on the recovery of elderly if they return to Agriculture after TKA.

Objective

Realize if elderly people between 65 and 80 years old, patients of Pêro da Covilhã Hospital, with Agricultural activity before surgery and submitted to TKA, with medial approach and posterior cruciate ligament sacrifice for the first time, can return to Agriculture and how long does it take; otherwise, identify the reasons for the interruption. Secondarily, analyse if Body Mass Index (BMI), gender, job, among others, influence this return.

Methods

This is an observational retrospective study with 38 patients between 65 and 80 years old submitted to TKA. Data was collected through clinical processes and patients self-report Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and analysed on SPSS and R software (statically significant p < 0.05).

Results

Of the 38 patients, 76.3% were female. Average age was 72.21 ± 4.50 and 75.13 ± 5.01 years old at the time of TKA and at the time of the questionnaire, respectively. On both moments the majority of the individuals had overweight or obesity. 84.2% returned to Agriculture (81.2% partially and 18.8 % fully), on average 6.34 ± 4.90 months after TKA. The median age at the surgery of the seniors who didn’t return to Agriculture is superior to the one of the seniors who returned (p = 0.025). The higher score in Stiffness and the lowest total score on WOMAC was seen in the individuals who returned four or more months after TKA (p = 0.0125 and p = 0.026, respectively).

Conclusions

The majority of the individuals between 65 and 80 years old, with Agricultural activity before surgery and submitted to TKA with medial approach and posterior cruciate ligament sacrifice, can return to Agriculture, in 6 months. Most of them don’t return fully. The most cited reason was surgery consequences. The median age at the time of TKA of the seniors who didn’t return is superior to the one of the seniors who returned. A worst score in Stiffness and a better Total score was seen in the seniors who took longer to return to Agriculture.

1Instituto Superior Miguel Torga, 3000-132 Coimbra, Portugal; 2Cognitive and Behavioural Center for Research and Intervention, University of Coimbra, 3001-802 Coimbra, Portugal; 3Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal

Correspondence: Ana Galhardo (anagalhardo@ismt.pt)

Background

Teaching has the potential to provide high satisfaction levels but it is described as a demanding profession with multiple sources of stress. Teachers’ psychological well-being is essential not only for themselves abut also for students. Experiential avoidance of private events (e.g., thoughts, feelings, body sensations) has been pointed as a key construct linked to psychopathological symptoms. The Teachers Acceptance and Action Questionnaire (TAAQ) is a teacher-specific measure developed to target experiential avoidance related to the teaching activity.

Objective

The current study sought out to develop the Portuguese version of Teachers Acceptance and Action Questionnaire (TAAQ-PT), explore its factor structure and psychometric properties in a sample of Portuguese teachers teaching in the 1st, 2nd and 3rd basic cycles and secondary education.

Methods

A sample of 304 teachers, 256 women (84.2%) and 48 men (15.8%) was recruited through teachers’ professional associations. Participants completed online a sociodemographic and professional questionnaire and a set of self-report instruments: the TAAQ-PT, the Depression Anxiety and Stress Scale 21 (DASS – 21), the Utrecht Work Engagement Scale (UWES), and the Five Facet Mindfulness Questionnaire (FFMQ). TAAQ-PT confirmatory factor analysis was conducted and reliability and validity were estimated.

Similar to the original version, confirmatory factor analysis revealed that the single-component model fits the data well. It showed good internal consistency, and correlations with other mental health measures suggested good convergent and discriminant validity. The TAAQ-PT was found to be a valid and reliable measure of experiential avoidance in teachers to be used in clinical and research contexts.

O107 Youth sports injuries according to health-related quality of life and parental instruction

Lara C Silva1,2, Júlia Teles2,3, Isabel Fragoso1,2

1Laboratory of Physiology and Biochemistry of Exercise, Faculty of Human Kinetics, University of Lisbon, 1499-002 Dafundo, Portugal; 2Interdisciplinary Center for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, 1499-002 Dafundo, Portugal; 3Mathematics Unit, Faculty of Human Kinetics, University of Lisbon, 1499-002 Dafundo, Portugal

Correspondence: Lara C Silva (laras@uatlantica.pt)

Background

Participation in physical activity involves a risk of injury that has a considerable public health impact [1]. Sports injuries are the major cause of morbidity among children and adolescents in developed countries [2]. They account for half of all injuries in school age children. The relationship between sports injuries, health-related quality of life (HRQoL) and parental instruction is still not clear.

Objective

Determine sports injuries biosocial predictors in Portuguese youth.

Methods

Information about HRQoL, parental instruction and sports injuries was assessed via three questionnaires; KIDSCREEN-52 [3,4], RAPIL II [5,6] and LESADO [1,7,8] respectively. They were filled by 651 subjects aged 10 to 18 years, attending four Portuguese community schools. Univariate analyses were used to verify significant differences between groups. Logistic, linear and multinomial regression analyses were used to determine significant biosocial predictors of injury, injury rate, injury type and body area injury location.

Results

Injury rate was higher in boys with lower scores in the school environment dimension of KIDSCREEN-52 (p = .022) and in girls was higher in those with lower scores in the moods and emotions dimension (p .001) and higher scores in the self-perception dimension (p < .001). Also in girls, upper limbs injuries were associated with higher scores in the moods and emotions dimension, and the spine and torso with lower scores (p = .037). Lower limbs injuries were associated with lower parents’ education and upper limbs (p = .046) and spine and torso (p = .034) injuries with higher parents’ education.

Conclusions

Surprisingly given the large number of injuries resulting from participation in sports and the associated high costs of health care, very few investigations have been conducted into biosocial variables and their relation to sports injuries. Injuries in the Portuguese youth were linked to three dimensions of KIDSCREEN-52 (moods and emotions, self-perception and school environment) and parents education level. Sports injuries usually result from the combination of several risk factors interacting at a given time [9]. Understanding the role of social and environmental factors related to sports injuries is needed, as they can be a part of this complex equation.

Acknowledgements

We would like to express our immeasurable gratitude to Ana Lúcia Silva and João Albuquerque for helping in data collection, and Carlos Barrigas for evaluating all x rays. We also thank to Escola Básica 2,3 Professor Delfim Santos, Agrupamento de escolas de Portela e Moscavide and Escola Secundária Quinta do Marquês, for making both their infrastructures and students available for the study and to all participants for their time and effort. Lara Costa e Silva, Ana Lúcia Silva e João Albuquerque were supported by a scholarship from the Portuguese Foundation for Science and Technology (SFRH/BD/77408/2011), (SFRH/BD/91029/2012), and PTDC/DES/113156/2009, respectively) and by the Interdisciplinary Center for the Study of Human Performance (CIPER).

Correspondence: Fernanda Silva (f.m.a.s_298@hotmail.com)

Background

As a result of the ageing process, there is evidence of a decline in physical aptitude (strength, endurance, agility and flexibility) associated with a lower performance in the activities of daily living [1]. Physical activity plays therefore a key role in maintaining the health and physical fitness of the elderly [2]. The recommendations on physical activity for health suggest that the elderly should perform at least 30 minutes of moderate- to vigorous-intensity activity per day [3, 4].

Objective

The aim of this paper is to accurately quantify physical activity time in the elderly and to verify the existence of differences regarding physical fitness levels between two groups of people: those who complied and those who did not comply with the Global Recommendations on Physical Activity for Health [4].

Results

This cross-sectional study sample includes 36 elderly individuals (72.28 ± 6.58 years old), both male and female, divided into two groups: the group which has fulfilled the recommendations (N = 16; 53.76 ± 24.39 minutes) and the group that has not fulfilled the recommendations (N = 20; 15.95 ± 7.79 minutes). Physical activity was assessed for 3 consecutive days and 600 minutes of daily recording, at least. The ActiGraph® GT1M Accelerometer was hence used. The “Functional Fitness Test” battery (Rikli and Jones) was used to assess the physical and functional autonomy of the elderly [5]. In order to analyse data, descriptive and inferential statistics were used. The Shapiro-Wilk test was applied to assess normality, whereas the Mann-Whitney test and the t-Test were used for independent samples.

Results

On average, participants spent more time in sedentary activities than in physical activity. The group which has fulfilled the recommendations on physical activity has achieved better results on almost all physical fitness tests: 30 s chair stand (repetitions), arm curl (repetitions), 6-minute walk test (m), 8-foot up-and-go (s). However, no significant difference was found between the groups.

Conclusions

The results therefore suggest that only 44.4% of the evaluated participants complied with the Global Recommendations on Physical Activity for Health. Evidence also suggests that the adherence to these guidelines might have a positive influence on the physical fitness of the elderly, particularly muscular strength, endurance and agility, but not flexibility.

Acknowledgements

This work was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest – OE/CED/UI4016/2016).

4. Department of Health. Start Active, Stay Active: A report on physical activity for health from the four home countries’ Chief Medical Officers. London: Department of Health; 2011. Available from: https://www.sportengland.org/media/2928/dh_128210.pdf.

Correspondence: Rogério Salvador (rogerio.salvador@ipleiria.pt)

Background

To independently accomplish their daily routines with no need of assistance, older adults require an optimal physical fitness. In fact, this lack of physical fitness may reduce older individuals’ quality of life, leading to dependence on personal daily assistance or even to becoming significantly more prone to fatal falls [1]. Prevention through physical activity programs, are used to slow down and delay these aging effects, by improving individuals’ agility, flexibility and body improved functionality. Most of these programs take place in in-water environment due to age limiting factors such as high-risk osteoporosis, reduced mobility, higher risk of fracture from falls, arthrosis and spinal disorders among other.

Objective

To assess the effects of two strength and conditioning programs in strength and dynamic balance in older adults.

Methods

One hundred elderlies (36 males and 64 females) aged 67.3 ± 5.2 years old enrolled the 5-year long intervention program and were assessed for lower body strength (LBS) and dynamic balance (DB). Two intervention programs were set up and subjects were included in each group according to their own will. Program A (n = 52; 24 males and 28 females; age 67.2 ± 5.2 y-o) consisted of 1 in-water session and 2 in dry-land sessions per week. Program B (n = 48; 12 males and 36 females; age 67 ± 5.2 y-o) consisted of 2 in-water sessions and 1 in dry-land session per week. Wilcoxon test was used on inferential analysis for repeated measures (pre-post). Significance level was kept at 5%. The effect size for this test was calculated by dividing the z value by the square root of N [2].

Strength and conditioning programs over a 5-year time span seem to substantially delay the negative effects of aging on LBS/DB in the elderly. No visible decline in the assessed parameters was observed. Our results may suggest different effects of in-water and dry-land programs. However, participants generally responded positively to both intervention programs.

Correspondence: Marina Cunha (marina_cunha@ismt.pt)

Background

Research has been showing potential benefits of compassion practice in various populations, nonetheless it is relevant to extend the assessment of compassion attributes and actions for adolescents and explore its relationship with other psychosocial adjustment constructs.

Objective

To explore association patterns between the various directions of compassion (self- directed, directed to others and receiving compassionate from others) and variables related to affect, social comparison and peers’ attachment to quality.

Methods

A total of 338 adolescents, aged between 12 and 18 years old, completed a set of self-report instruments to assess their compassionate attitudes and actions towards themselves and others (EAAC), peers attachment to quality (AQ-C), positive and negative affect (PANAS), and peers social comparison (SCS-A).

Results

Significant correlations were found in the expected direction between self-compassion, compassion for others and received from others and the study variables (positive and negative affect, social comparison and attachment style). Specifically, positive affect, positive peer comparison, and secure attachment style were positively associated with compassionate attributes and actions. Negative affect, in turn, showed a negative correlation with compassionate actions in the three analysed directions, and with compassionate attributes when considering receiving compassion from others. The avoidant unsecure attachment style revealed a negative association with compassionate attributes and actions in the different directions. Finally, the ambivalent insecure attachment style revealed a significant negative correlation with self-directed compassionate actions and with receiving compassion from others, regarding actions and attributes.

Conclusions

These findings suggest the importance of stimulating a compassionate mind in adolescents. In fact, the positive association between compassion and psychological and emotional adjustment variables point to the relevance of developing compassion skills during this developmental stage.

Correspondence: Gabriela Brochado (gabriela.brochado@ipsn.cespu.pt)

Background

World Health Organization (WHO) defined work-related musculoskeletal injuries as multifactorial diseases. These injuries are the main concern of public health and individual health, and are becoming increasingly frequent, in both developed and developing countries. Workers during working hours are often exposed to repetitive movements, the lifting and carrying heavy loads, verifying an increase in demand in terms of muscle strength in the upper limbs. The palmar grip strength provides an objective index of the functional integrity for the evaluation of upper limbs.

Objective

Verify that the palmar grip strength is associated with self-reported symptoms in the arm in industry worker’s electrical components.

Methods

An observational, analytical study was performed on a sample of 167 workers. The Nordic Musculoskeletal Questionnaire was applied and the palmar grip strength was measured using the hydraulic dynamometer. Descriptive statistics were used to analyse the prevalence of self-reported symptoms and the U test of Mann-Whitney, Kruskal-Wallis H test, Chi-square test and Fisher's exact test was used to analyse relationships between variables, with a 95% confidence level.

Results

The palmar grip strength was related to self-reported symptomatology in the dominant upper limb, shoulder regions (p = 0.018) and wrist (p = 0.005) in females. It was also found that the risk factors are not associated with palmar grip strength in individuals of both genders.

Conclusions

Palmar grip strength is associated with self-reported symptomatology in the shoulder and wrist of the dominant upper limb in female workers.

Correspondence: Luisa Aires (luisa.aires@gmail.com)

The Knowledge of behaviours and social-skills of adolescents can contribute to the construction of an effective school-based intervention to promote healthy lifestyles.

Objective

Identify homogeneous groups (clusters) according to lifestyle and social skills.

Methods

This cross-sectional study included 1,008 students from 5 elementary schools of Tâmega and Sousa region, mean age of 13.43 (SD = 1.1) and 50% of girls. A sociodemographic questionnaire “My Lifestyle” was used with 28 items composing 4 subscales: Physical Exercise (PE), Nutrition, Self-Care, Monitored Safety, Use of Drugs and Similar (UDS) (0.41< α <0.85). A “Social Skills Inventory for Teenagers” questionnaire (Social-Skills) was applied, including subscales: Empathy, Civility, Assertiveness, Self-Control, Affective Approach and Social-Development (0.64< α <0.90). Both questionnaires had 5 categories of answers from “almost always” to “almost never” or “rarely”. In order to identify homogeneous groups of students, according to lifestyle and social skills, it was performed a k-means cluster analysis

Results

For Lifestyle, mean scores were: UDS = 4.09, Self-Care = 4.07, PE = 3.86, Monitored Safety = 3.63 and Nutrition = 3.40. For Social-Skills, 50.7% had a highly elaborate repertoire of Social Skills, 11% had elaborate repertoire, 20.1% had good repertoire and 2.7% had lower average of social skills repertoire. It was decided to follow a three-cluster solution. Cluster 1 included students with a poor elaborated repertoire of social skills, but with good lifestyle indicators in all subscales. In cluster 2, students had a good repertoire of social skills, with good lifestyle indicators in all subscales, except for subscales of nutrition with poor indicators (38.7) and Monitored Safety (46.95). Cluster 3 included students with highly developed repertoire of social skills and the best lifestyle indicators.

Conclusions

Results revealed healthy practices in general, however students had the lowest scores in Nutrition, especially in sugar intake and absence of dietary plan. Students included in cluster 2 presented also the lowest results in Monitored Safety, especially about driving with alcohol. These students at risk of develop unhealthy lifestyle need special attention. The high profile of social skills in particular Affective Approach and Assertiveness, should be taking into account as a mechanism for intervention programs. In addition, relevance given to PE, should also be used as a good strategy to reinforce the accomplishment of healthy eating habits in all students. In another point of view, good indicators of lifestyles (cluster 1) can act as matrix to reinforce improvements in social-skills.

Keywords

Adolescents, Lifestyle, Social Skills.

O113 Palliative care: nursing student’s conceptions and motivations

Suzana Duarte, Vitor Parola, Adriana Coelho

Escola Superior de Enfermagem de Coimbra, 3046-851 Coimbra, Portugal

Correspondence: Suzana Duarte (susanafcduarte@gmail.com)

Background

Palliative care (PC) is an inevitability in view of the demographic and epidemiological transition curves of Western society. The inclusion of a PC Curricular Unit (CU) in the Nursing Undergraduate Program (NUP) translates into the acquisition of competencies that allow caring for people and families in need of those carefulness. Although considering professional, institutional and family barriers, there is evidence that students apply, in clinical practice, the principles inherent of PC [1]. During clinical education, students are confronted with persons in need of PC, however without benefiting from such care. These experiences can form the basis, from which, it is possible to build the teaching-learning process of future nurses, regarding this theme.

Objective

To identify the conceptions and motivations for the frequency of the CU option of PC, by nursing undergraduate students'.

Methods

In the first class, nurses’ students were asked to anonymously write what they understood as PC and the motivation for attending this CU. The 210 responses collected over 5 years were subjected to content analysis [2].

Results

The PC conceptions reported were grouped into the categories: “Care for people in the final stages of life”, “Care to alleviate suffering” and “Comfort care”. The reasons for choosing the PC option were grouped in “Difficult and not tackled area”, “Area that arouses more interest” and “Previous Experiences”. It is verified that the concept of PC remains as care for people in terminal phase of life and in suffering. Some students report experiencing situations that would lead to PC, conditions of therapeutic obstinacy and end of life in circumstances of intense suffering. Students also mention the nurses ‘attempts to provide those carefulness, which is not well favoured for, in the hospital wards. Students indicate interventions that are intrinsic to palliative care, such as, communication, psychological support, coping with death and mourning, without any reference to the need for knowledge in other areas, namely pathology, pharmacology, or maintenance and healthcare technologies. The orientation of care for quality of life, family integration and management of symptoms is not considered.

Conclusions

There is a need to include in each NUP a PC CU, preferably after a period of clinical education in hospital wards. In this way it is possible to consider the previous experiences of the students, capitalizing them to the understanding of the fundamental principles of Palliative Care.

Correspondence: José A Parraça (jparraca@uevora.pt)

Background

Overweight and Obesity are defined as an abnormal or excessive fat accumulation and present a health risk. Binge eating is a food disorder characterized by episodes of abusive food intake in the absence of regular compensatory behaviours such as vomiting or abuse of laxatives. Those who suffer from this disorder often increase their weight and fat mass by excessive intake of calories, thus becoming overweight or obese.

Objective

To determine the relation between the effects of an exercise and nutrition program, in overweight or obese adults (30-60 years) and binge eating, regarding body composition and physical fitness. The program also aimed to promote learning and self-control in the practice of physical activity and in the food choices of this population.

Methods

41 patients from USF Planície de Évora. Groups were randomly assigned: the experimental group (N = 23) and the control group (N = 18). The study lasted eight months and consisted of 47 practical sessions of one-hour group exercise, twice a week, one weekly self-help session, and three sessions of nutritional monitoring throughout the program. Practical sessions were structured with specific exercises aimed at improving the different components evaluated; namely in physical fitness (strength, cardiovascular endurance and flexibility) and body composition (fat loss).There were significant improvements in body composition, namely in the percentage of fat mass (40.75 (±6.46) to 37.44 (±7.06) p = .000), fat free mass (59.98 (±6.44) to 62.26 (±7.56) p = .001), of fat mass in the trunk (35.95 (±4.90) to 32.06 (±4.93) p = .000), in the Visceral index (12.00 (±3.42) to 10.88 (±2.97) p = .000) and in metabolic age (59.88 (±9.35) to 55.94 (±7.92) p =. 024). There were improvements in physical fitness, mainly in trunk flexibility (-0.18 (±9.72) to 8.93 (±10.06) p = .002) and in leg strength (0.10 (±0.03) to 0.13 (±0.02) p = .034) and arms (25.48 (±8.91) to 30.81 (±7.68) p = .000). Regarding weight, there is a tendency to significance, since there was a significant improvement (92.25 (±12.73) to 88.93 (±13.77) p = .056).

Conclusions

We conclude that the physical exercise and nutrition program allows improvements in physical fitness and body composition in the obese population suffering from binge eating.

Keywords

Exercise, Nutrition, Obesity, Body composition, Food addiction.

O115 Exploratory analysis of the association between motives for the practice of physical exercise and body composition

Correspondence: Roberta Frontini (roberta_frontini@hotmail.com)

Background

Understanding what reasons lead individuals to start and maintain physical activity is extremely important to help individuals to engage and adhere to physical exercise. It allows exercise professionals to define the most appropriate actions to implement more suitable strategies and remove possible barriers to exercise. The decrease in body fat mass may be indirectly related to the motivation that the individual has for the practice of the physical exercise. Higher levels of motivation to lose weight may be related with higher adherence to, for example, the training plan and, consequently, be related to higher levels of body mass fat reduction.

Objective

This study aimed to analyse the association between body fat and motives to practice physical exercise.

Methods

The sample comprised 85 adults (38 males and 47 females) attending the gym, who completed a sociodemographic form and the Exercise Motivations Inventory - 2 (EMI-2). A multiple regression analysis was used to predict the value of a %body fat (%BF) based on the value of survey categories. The significance was set at p < 0.05. The statistical procedures were made in SPSS software (version 23.0, IBM, USA).

Social variables (specifically social recognition), positive health and weight management are important for body mass fat reduction, more than variables related, for example, with health concerns. It is important, in future studies, to understand what processes influence those relations. The results of our study reinforce the importance of these three variables for the reduction of body fat mass emphasizing that it may be important to take these issues into account not only to maintain the adherence of individuals, but also to promote the practice of physical exercise.

Correspondence: Luís Ramos (luis_filipe-ramos@hotmail.com)

Background

Nowadays, the use of laboratories with specific equipment and classes with resource to simulated practice, are increasingly advocated, especially in graduation courses, whose practice is a crucial tool for students to apply in real life situations.

Objective

Therefore, we intended to know the perception of students and teachers of a nursing degree, on the use of simulated practice as a pedagogical strategy.

Methods

To achieve this, we developed a research study using a qualitative approach and a semi-structured interview applied to six students of the nursing graduation course and to seven teachers who teach classes, with the resource of simulated practice, at Escola Superior de Saúde de Leiria.

Results

From the results we verified that for teachers, simulation is a pedagogical strategy in the development of the students’ competences, in a way that will translate in a provision of care based on the scientific knowledge, safety and humanism that is expected from a health professional. However, from the students’ perspective, we verified that the results indicate that the simulation is undoubtedly an added value, since the interviewees were able to approach the concept of simulated practice at several levels, also enabling to highlight the partnership between the pertinence and the contributions of the simulation and, finally, to mention several constraints and respective solutions.

Conclusions

As Goostone et al., (2013) [1] states, simulation is a pedagogical strategy that allows the student to acquire skills necessary for clinical practice, in a risk-free real environment, that is, students are faced with a clinical situation like what they would find in a real clinical environment, receiving feedback on their performance. Thus, it’s fundamental that there are teachers with the necessary training to implement this type of pedagogical strategy, as well as the necessary resources, associated to the will and commitment of the students. This triad is essential for the development of the students’ competencies as future professionals. In summary, the groups interviewed highlighted the importance of simulation, being able to answer to our research questions, complementing each other, once they recognized the importance of simulation in the health field.

Correspondence: Paulo Teixeira (paulo.teixeira@estescoimbra.pt)

Background

Human epidermal growth factor receptor 2 (HER2) is overexpressed in 20 to 30 % of breast cancer, as well as in others human cancers [1,2]. The Dual in-situ hybridization (DISH) assay is widely used to study HER2 status, and gives predictive and therapeutic information in invasive breast cancer, although it is dependent on pre-analytical variables, as ischemic time and fixation, among others [1,3].

Objective

The aim is to implement a HER2 DISH assay, contributing to its optimization and decrease of variability, clarifying the pre-analytical and analytical variables, with impact in tissue staining and morphology.

Methods

Forty-four (44) cases of invasive breast cancer cases previously scored with HER2 2+, were included in this study. Thin 4 μm paraffin sections were submitted to DISH. Unsuccessful cases were submitted to subsequent DISH protocols to attempt a valid result. Slides were evaluated according to staining and morphology integrity, by three independent observers proficient in this methodology, in a blind way, with a light microscope.

Results

From the 44 cases, 30 (68.2%) were readily validated, since 14 (31.8%) showed nuclear vacuolization and morphologic disruption leading to further tests with optimized protocols. Unsuccessful cases showed severe morphology damage and were reprocessed with further optimized protocols.

Conclusions

According to the obtained results, we can conclude that the pre-analytical variables with major impact on the standardization of the results were time of cold ischemic; unsliced operatory specimens and length of fixation. Analytical variables as time and temperature of cellular permeabilization can be changed to improve inadequate tissue preservation.

Correspondence: Maria Almeida (mlurdes@esenfc.pt)

Background

As the human body ages, its function also tends to decline resulting in a higher risk of development of diseases. This leads to the presence of multiple and complex medications in the life of many older adults (OA). As the self-management and adherence behaviours of these medications require the development of competences, it is important to develop a quick and easy instrument to provide systematized data for the health professional that will allow a better decision-making process and a higher probability of developing interventions with impact in the medication-taking ability of the OA. With this purpose, AGITE was developed following a process of systematic literature review, content analysis and psychometric testing, resulting in a total of nineteen questions with a Likert scale approach. Previous studies demonstrated the need for further testing of its psychometric properties.

Methods

After application of the AGITE to 146 elders in day centres in Central Portugal, exploratory factorial analysis (EFA) using the eigenvalue criteria, and internal consistency (IC) through Cronbach’s Alpha were performed.

Results

From the EFA, using varimax rotation and screen plot analysis, an acceptable KMO of 0.653 was obtained, with no items being eliminated through analysis of anti-image matrix. A total of five dimensions emerged explaining 53.6% of the variance: “Engagement”, “Neglect and External Influences”, “Perceived Benefits”, “Healthcare Professionals Support”, and “Value assigned to Written Information”. Through analysis of the items of each dimension, higher scores of “Engagement” indicate a responsible attitude towards self-management and adherence, while higher scores of “Neglect and External Influences” demonstrate a tendency to cease medication, according to individual and non-professional external beliefs. Regarding the dimension “Perceived Benefits”, higher scores evidence how the elder positively perceives the effects of the medication, while higher scores of “Healthcare Professionals Support” are related with perceived importance of the healthcare professionals in the medication-taking ability. Higher scores of “Value assigned to Written Information” demonstrate a tendency to attribute significance to written data regarding medication. Overall the questionnaire dimensions demonstrate questionable to acceptable IC (0.6 < α < 0.8).

Conclusions

New analysis of the psychometric properties evidences the emergence of new dimensions, allowing for a wider understanding of the profile of the medication-taking ability of the elder population in Portugal. These new dimensions will provide a better analysis of this skill to the healthcare professional, allowing a more personalized intervention, with higher chance of success.

Correspondence: Pedro Garcia-Ramiro (pgramiro@ujaen.es)

Background

Researchers, stakeholders and policy makers agree about the importance of the population ageing in modern societies. Emotional Intelligence (EI) has generated a broad interest in the scientific community in Spain [1]. Prestigious social scientists from different lines of research contribute to assess important theoretical and empirical topics on this construct [2]. Aging is a process during which important changes occur in different areas of development and emotional intelligence plays an essential role. Throughout the years, the subject of death has been conceived in different ways. People abstain from talking about it, and a conduct of avoidance can be observed manifesting itself in fear and anxiety [3].

Objective

The objective of this study was to examine the relationship between emotional intelligence and fear of death in an older population.

Methods

A Spanish sample of 384 older people aged 65 years and older (51.82% women; 71.23 ± 8.34 years of age), without cognitive impairment, were included in this descriptive and correlational study. Data on emotional intelligence and fear of death were obtained through the TMMS-24 and Collett-Lester scales, respectively.

Results

Structural equation modelling indicated that emotional intelligence exerted an influence on fear of death. The emotional perception component was positively correlated with the fear of death (r = 0.14; p < 0.05), while understanding and emotional regulation were negatively correlated with fear of death (r = -012; p < 0.001). The higher scores for fear of death were associated with the female gender, and singles. These aspects underscore the importance of the results of this study.

Conclusions

These findings show that high levels of emotional intelligence were associated with less fear of death. After controlling sociodemographic variables, the EI dimensions, emotional perception and emotional regulation, accounted for part of the variance in several fears of dead facets. These dimensions can have an important role in the fear of dead of older people.

O120 Vitamin D in food supplements: are we taking too much?

Isabel M Costa, Alexandra Figueiredo, Deolinda Auxtero

Instituto Universitário Egas Moniz, 2829-511 Caparica, Portugal

Correspondence: Alexandra Figueiredo (alexandra.f@netcabo.pt)

Background

Over the last years, an increase in vitamin D (VitD) supplements intake has been observed. Evidence has suggested multiple effects of VitD beyond bone homeostasis. Low VitD levels are associated with numerous disorders including diabetes, cancer, cardiovascular disease, Parkinson's disease, among others. Consumers have the general misperception that “vitamin” denotes something harmless and vital, disregarding its potentially harmful effects. Although vitD toxicity is uncommon, case reports attributed to vitD supplementation have raised. Being a fat-soluble vitamin, excessive supplementation may result in body accumulation and toxicity. It increases intestinal calcium absorption and plays a central role in its homeostasis. Thus, most symptoms of toxicity result from hypercalcemia. Adverse effects include gastrointestinal disorders (anorexia, diarrhoea, nausea, vomiting), muscle and joint pain, cardiac complaints, hypertension, central nervous system effects and renal disorders (polyuria, polydipsia).

Objective

The aim of this study was to evaluate whether VitD3 (cholecalciferol) daily dose indicated on food supplements (FS) labels coincided with the recommended daily allowance (RDA) for this vitamin defined by the European Union Directive.

Methods

Labels of 110 FS sold in Portuguese pharmacies, supermarkets or health shops were examined. Selection criteria included: oral solid pharmaceutical forms for adults, containing vitD in its composition, as stated in the label, regardless of the purpose of the FS.

Results

66.4% of FS presented vitD label doses above RDA and four of them indicated a daily dose ≥ the tolerable upper intake level defined by EFSA (UL=100 μg/day). In the majority of the FS evaluated, vitD label dose far exceeded RDA value and some exceeded UL defined by EFSA.

Conclusions

At present, the safety of FS and the authenticity of label information is exclusively ensured by the economic operators who place FS on the market. Since FS are usually taken without any medical supervision or counselling and attending the potential adverse effects of vitD excess, it is imperative that the daily doses of vitD present in FS are reviewed attending to RDA values. Authors also suggest that FS should be under the same quality control of pharmaceuticals, regarding FS consumers health.

O121 Functional ability and risk of falling - a base for exercise prescription

Sílvia Vaz, Anabela Martins, Carla Guapo, Sara Martins

Correspondence: Sílvia Vaz (leontina_vaz@hotmail.com)

Background

Falls are currently considered one of the most common and serious public health problems [1, 2]. Faced with this problem, it becomes necessary to explore which factors can better predict the risk of falls in individuals living in the community [3], so that, preventive measures can be considered.

Objective

To identify fall risk indicators and to relate them to exercise prescription levels; to relate the history of falls, the functional capacity (measured through the Timed Up & Go, 10-meter walking speed test, Step test) and the fall risk factors and propose a guide based on those relations to address exercise prescription.

Methods

Descriptive and exploratory study. Two hundred community dwelling adults aged 55 or older were assessed, integrating two sub-samples, a Portuguese and a Polish. Study participants were assessed for socio-demographic data, history of falls, fear of falling, exercise, sedentary lifestyle, hearing problems and/or dizziness, visual problems, alcohol consumption, exercise self-efficacy and confidence in activities of the daily life (FES-Portuguese version). Functional capacity was assessed by three golden measures for the risk of fall: the Timed Up and Go (TUG), the 10-meter walking speed test and the Step Test (15s). The statistical design included descriptive analyses, inferential analyses (bivariate: t-test for independent samples, One-Way ANOVA and Pearson’s correlation coefficient).

Results

Fall incidence was 39.5% and 45.3% in the total and Portuguese samples, respectively. TUG, 10-meter walking speed test and step test can distinguish those with history of falls from those without, with statistically significant differences (p ≤ 0.05). Taking more than 4 different medications per day, fear of falling, hearing problems and/or dizziness and the need for help getting up from a chair were correlated to the history of falls, the TUG, the walking speed and the step test (p ≤ 0.05). The sedentary lifestyle and the use of assistive devices were associated with worst performance in the functional tests (p < 0.05) in the Portuguese sample. TUG, 10-meter walking speed test and step test were correlated with exercise self-efficacy.

Conclusions

The incidence of falls is higher than literature has reported and it is inversely associated with the functional capacity of community-dwelling adults aged over 55 years old. Data from this study is a valuable basis for exercise prescription, taking into account the levels of risk and the components of exercise prescription.

Correspondence: Mário Lopes (mariolopes77@ua.pt)

The effects of the FIFA 11+ on physical performance parameters has demonstrated controversial results.

Objective

The aim of this study was to observe the short and long-term effects of the FIFA 11+ on performance in male amateur futsal players.

Methods

Seventy-one (71) male futsal players from six amateur clubs were randomized to an intervention (N = 37, age: 27.0 ± 5.1 years) or a control group (N = 34, age: 26.0 ± 5.1 years). The intervention group was submitted to 10 weeks of FIFA 11+ injury prevention program, 2 sessions/week, followed by a 10-week follow-up period, while the control group performed regular futsal warm-ups during the training sessions. During the follow-up period both groups performed only regular warm-ups during their training sessions. Physical performance was assessed by measuring agility (T-test), sprint (30-meter sprint), flexibility (sit and reach) and vertical jump performance (squat jump).

Results

Differences between groups were found at baseline for training exposure, body mass index, body weight, flexibility and sprint. The results of the effect of the FIFA 11+ on the sit and reach, speed, jump performance and agility did not show differences pre-post intervention after adjustment for the baseline differences, as well as for the 10-week follow-up.

Conclusions

The current study has shown no short and long-term performance enhancement in sprint, flexibility, agility and jump performance after the FIFA 11+ in male amateur futsal players.

Correspondence: Pedro Morouço (pedro.morouco@ipleiria.pt)

Background

There are several evidences in the literature demonstrating a high positive association between increased levels of exercise and improved health, specifically in older adults [1]. As such, in recent years there has been a large number of studies examining the benefits imposed by different types of exercise (e.g. resistance training [2], and aquatic fitness [3]). However, in addition to the benefits imposed, it is crucial that the exercise is motivating and challenging.

Objective

It was aimed to examine the possible effects on conditioning induced by 8-weeks of aquatic fitness, in female older adults.

Methods

Fourteen women (64.3 ± 7.3 years old) enrolled in bi-weekly aquatic fitness of 45’ sessions for 8 weeks. Before and after the 8 weeks, participants performed the Senior Fitness Test [2], hand-grip strength and body measures. All participants were volunteer, informed consent was obtained and all procedures were in accordance to Helsinki Declaration. Sessions were instructed by a CSCS®.

Eight weeks of aquatic fitness induced extensive benefits in older women conditioning, suggesting that this activity is able to promote an increase in life quality. The present results corroborate previous studies, demonstrating that aquatic exercise is a reliable approach for improved health in the elderly.

Acknowledgements

This research was supported by the European Regional Development Fund (FEDER), through COMPETE2020 under the PT2020 program (POCI-01-0145-FEDER-023423), and by the Portuguese Foundation for Science and Technology (UID/Multi/04044/2013).

O124 Predicting social participation in the community-dwelling older adults

Carla Guapo, Anabela C Martins, Sara Martins, Sílvia Vaz

Correspondence: Sílvia Vaz (leontina_vaz@hotmail.com)

Background

Nowadays, active ageing is both a complex scientific term and a goal for most people, but also an undeniable political objective [1]. Participating socially helps to develop the feeling of belonging to a community and allows everyone to see each individual contribution in upholding the community [2-4].

Objective

Characterize the profile of community-dwelling adults aged 55 or older, regarding social participation, functional capacity (walking speed, grip strength, lower limb strength, static and dynamic balance) and personal factors (age, gender, BMI, confidence/fear of falling and perception of general health); verify the relationship between social participation and functional capacity as well as participation and personal factors; and find, among all the variables, which can be the best predictors of social participation.

The results have shown that this sample was composed mostly by women, mean age approximately 69 years old. Statistically significant associations between social participation and all study variables: Age (r = 0.301, p = 0.00), BMI (r = 0.169, p = 0.039), Grip strength (r = -0.318, p = 0.00), Pressure platform Hercules® (r = -0.337, p = 0.00), perception of general health (r = 0.468, p = 0.00), Timed Up & Go (r = 0.668, p = 0.00), T10M (r = -0.576, p = 0.00), Test Step (r = -0.456, p=0.00) and Fall Efficacy Scale (r = 0.768, p = 0.00). Regression analysis shows that the confidence in performing activities of the daily living without fear of falling, health perception and dynamic balance, measured by Timed Up & Go test, as a whole, are responsible for 65.5% of the variance of social participation (R2 = 0.655; p < 0.001). Using a second model we have seen that a sizeable part of the variance percentage related to the participants’ social participation, 55%, is due once again to dynamic balance and health perception, followed by age (R2 = 0.549; p < 0.001).

Conclusions

The Timed Up & Go test and the unique question on health perception: “In general, would you say that your health is excellent, very good, good, satisfactory or poor?” account for a significant percentage of the variance in social participation in elderly individuals. Incorporating these two factors into the physical therapist's clinical practice takes very little time and greatly benefits the decision-making process and planning of interventions.

Correspondence: Miguel Rebelo (miguelrebelo7@hotmail.com)

Background

Motor development presupposes a set of life-long processes of change. These processes occur mostly during the first years of the child’s life, having each child different developmental rhythms [1]. Motor skills are fundamental to our day-to-day life, representing the key to the child's development [2]. As such, it is important to know the different factors that influence the development of motor skills during childhood. According to bibliography, the presence of siblings may be an important factor, because this relationship provides a basis for learning and socialization opportunities in various contexts [3].

Objective

The main goal of this study was to verify if there were differences in the development of motor skills (global and fine) through the scales of the PDMS-2, comparing children that have or do not have siblings.

Methods

In this study 91 children of both sexes participated (30.20 ± 10.56 months). Two groups were created: the sibling group, consisting of 48 children (31.06 ± 10.76 months) and the non-sibling group, consisting of 43 children (29.23 ± 10.37 months). Motor skills were assessed using the PDMS-2 test battery scales4. The evaluation was performed during 4 months, 3 times a week and individually (approximately 30 minutes for each child). For the data analysis, we used descriptive and inferential statistics. The Kolmogorov-Smirnov test was applied to test normality, and the Mann-Whitney test was applied to independent samples.

Results

The sibling group achieved, on average, better results in all motor skills (global and fine). However, there were only statistically significant differences in fine motor skills (p = 0.016), where the sibling group had the best results (average = 52.29) compared to the non-sibling group (average = 38.98).

Conclusions

These results show that the presence of siblings in the family context positively influences motor development, providing cooperative activities through play and challenges that improve cognitive, social, emotional and physical development.

Acknowledgements

This work was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest – OE/CED/UI4016/2016).

O126 Childhood obesity in the urban parishes of Coimbra municipality

Margarida Pereira, Cristina Padez, Helena Nogueira

Research Centre for Anthropology and Health, University of Coimbra, 3000-456 Coimbra, Portugal

Correspondence: Margarida Pereira (mmiguel06@gmail.com)

Background

Childhood obesity is a major public health concern worldwide and Portugal has one of the highest rates of childhood obesity among the European countries. It is known that childhood obesity is particularly high in urban settings. Thus, a deeper understanding of the impact of such areas in children weight is needed. Evidence suggests that parents’ perception of the neighbourhood safety might determine children weight once unsafety perceptions of the neighbourhood prevent children from playing outside.

Objective

This work main goal was to examine the impact of parents’ safety perception of the neighbourhood in children’s weight status regarding the localization of the neighbourhood (urban centre or urban periphery).

Methods

Weight (kg) and height (cm) of 1,493 children from Coimbra municipality were measured and BMI (weight/height2) was calculated to use IOTF cut-off points to classify children in “normal” or “obese”. Parents provided their parish of residence as well as their weight, height and number of schooling years. They also responded to a questionnaire regarding their neighbourhood perceptions and physical activity engagement of their children. The sample was analysed separately, i.e., chi-square tests were computed to children living in parishes from the urban centre and posteriorly to children living in parishes from the urban periphery.

Results

This study results showed proportionality between overweight or obese children residing in the urban centre, mainly girls, with low socioeconomic status and obese parents that strongly agree that their neighbourhood is unsafe to walk in during the day. Except for mother weight status, none of the variables analysed differentiated normal from overweight or obese children living in the urban periphery, regarding the chi-square tests.

Conclusions

Overall, parents’ perceptions of the environment might impact children’s weight status. However, even within the same urban area, perceptions of neighbourhood safety change. The aspects that influence children weight status differ according to the parishes they live in - urban centre or peripheric parishes. For example, parents from a significant proportion of overweight or obese children living in the urban centre parishes perceives their neighbourhood environment as unsafe to walk during the day, however, no differences were found between normal and overweight or obese children from the peripheric parishes. This should be held in consideration when developing healthy urban planning strategies.

Acknowledgements

Work funded by the Foundation for the Science and Technology (PTDC/DTP-SAP/1520/2014 and grant SFRH/BD/133140/2017).

Correspondence: Ana P Silva (ana.silva@estesl.ipl.pt)

Background

Cardiovascular disease is the most common cause of disqualification from competitive sports. The pre-participation screening is fundamental in order to detect these diseases and is based on clinical history and physical examination in addition to a 12-lead electrocardiogram. Additional tests are requested only for those with any abnormality in the initial evaluation [1-2]. According to previous studies, the most common cardiovascular diseases that disqualify young athletes are different from those associated to veteran athletes: congenital arrhythmias vs. subclinical coronary disease, respectively [3-5].

Objective

To analyse and compare, amongst young and veteran athletes, the cardiovascular causes of disqualification from competitive sports, consecutively screened at a sports medicine unit in a decade (2007-2017).

Methods

Descriptive-comparative retrospective study. The study population consisted of all case files from athletes disqualified from competitive sports due to cardiovascular disease during the 2007-2017 period. A sample of 58 case files was divided into group A (young athletes, < 35 years, nA= 36) and group B (veteran athletes, ≥ 35 years, nB=22). It was evaluated the clinical history, sport disciplines, symptoms and cardiovascular diseases. Descriptive statistics and statistical inference (Chi-squared distribution) were applied for the characterization and comparison of the study variables.

Results

Both sample groups consisted mainly in male athletes (group A 94.4%, group B 100%). The most referred symptom in group A was palpitations (16.7%), whereas in group B was chest pain (36.4%). There was a significant association between relevant cardiovascular history and veteran athletes. The most frequent cardiovascular diseases in group A were hypertrophic cardiomyopathy (19.4%), arterial hypertension (11.1%), left ventricle noncompaction (8.3%) and great vessel transposition (8.3%). Arterial hypertension (50%) and coronary disease (45.4% were the most frequent diseases that disqualified the practice of competition sports in veteran athletes. It’s important to emphasize that some veteran athletes presented simultaneously more than one cardiovascular cause of disqualification.

Conclusions

The most frequent cardiovascular diseases in groups A and B matched those found in literature [3-5]. The prevalence of hypertrophic cardiomyopathy and coronary disease in the respective groups may be associated with a higher awareness towards the dangers of these particular diseases in the practice of competition sports. The data in this study confirms the key role of pre-participation screening for the identification of cardiovascular diseases that can cause sudden cardiac death during sport.

Ivani N Carlotto, Maria AP Dinis

Correspondence: Ivani N Carlotto (ivani.carlotto@gmail.com)

Background

Universities are essential institutions for health promotion (HP) [1]. As they have their own ethos and distinct cultures, they may act as potential enhancers of the conceptual frameworks of HP and interdisciplinary values such as equity, social justice and sustainable growth [2]. Bioethics, as a transversal discipline, seeks to ethically analyse and systematize such values, strengthening the synergy between health and sustainability [3]. Bioethics is a reflexive, mutually shared and interdisciplinary tool whose goal is to promote health and sustainability in an integrated and coherent way, adapting life actions in their equitable and inclusive characters.

Objective

1) Identify how bioethics takes place in daily life and how it is possible to establish links between scientific and ethical knowledge, in order to avoid negative impacts on people's lives; 2) Describe the appropriate bioethical tools (principles) for intervention in the context of higher education (HE), HP and sustainability.

Methods

Exploratory-descriptive methodology using a quanti-qualitative approach [4]. Sample: University teachers from Rio Grande do Sul/Brazil, random sample, probabilistic sampling by convenience, CI = 95%, n = 1400 persons. The research was approved by the Research Ethics Committee of the Hospital de Clínicas of Porto Alegre (HCPA)/Brazil, Ethics Committee of the Universidade Fernando Pessoa (UFP)/Porto-Portugal, receiving the approval number CAAE 55066616.8.0000.5327/Plataforma Brasil/Brazil. The interviews were carried out after receiving the informed consent from the participants, taking into account the assumptions of the National Health Council Brazil (NHC) 466-2012.